Organization
JOHN D. NYDAHL, DDS, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D. NYDAHL DDS (PRESIDENT)
(320) 253-0744
Entity
Organization
Contact information
Practice address
1011 2ND ST N STE 101, SAINT CLOUD, MN 56303-3237
(320) 253-0744
(320) 253-9930
Mailing address
1011 2ND ST N STE 101, SAINT CLOUD, MN 56303-3237
(320) 253-0744
(320) 253-9930
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D8204
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55162NY
BLUE CROSS BLUE SHIELD
MN
01
—
D8204
DELTA DENTAL
MN
Enumeration date
07/27/2006
Last updated
08/22/2020
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