1992857601 NPI number — SUSAN LYNN HJORT DDS

Table of content: SUSAN LYNN HJORT DDS (NPI 1992857601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992857601 NPI number — SUSAN LYNN HJORT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HJORT
Provider First Name:
SUSAN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RESCH
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992857601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
927 TRETTEL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOQUET
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55720-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-879-1227
Provider Business Mailing Address Fax Number:
218-878-3800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FOND DU LAC HUMAN SERVICES DIVISION
Provider Second Line Business Practice Location Address:
927 TRETTEL LANE
Provider Business Practice Location Address City Name:
CLOQUET
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-879-1227
Provider Business Practice Location Address Fax Number:
218-878-2188
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  D10797 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 983227100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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