1790941425 NPI number — AFFILIATED PEDIATRIC DENTISTS PA

Table of content: JACQUELINE MARIE LOMANDO LMHC (NPI 1841671724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790941425 NPI number — AFFILIATED PEDIATRIC DENTISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED PEDIATRIC DENTISTS 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:
6
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:
1790941425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7373 FRANCE AVENUE SOUTH
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
55435-4558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-831-4400
Provider Business Mailing Address Fax Number:
952-893-3041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6060 CLEARWATER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-9468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-932-0920
Provider Business Practice Location Address Fax Number:
952-932-0929
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWOOD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
952-831-4400

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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