1336575539 NPI number — SCOTT L BJERKE DDS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336575539 NPI number — SCOTT L BJERKE DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT L BJERKE DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336575539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2130 CLIFF RD
Provider Second Line Business Mailing Address:
SIUTE 107
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55122-2485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-452-3112
Provider Business Mailing Address Fax Number:
651-688-0487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2130 CLIFF RD
Provider Second Line Business Practice Location Address:
SIUTE 107
Provider Business Practice Location Address City Name:
EAGAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55122-2485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-452-3112
Provider Business Practice Location Address Fax Number:
651-688-0487
Provider Enumeration Date:
09/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BJERKE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
651-452-3112

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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