| Organization Name: | NERNESS ENDODONTICS, P.C. |
| NPI Number: | 1063825701 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW NERNESS (PRESIDENT) |
| Mailing Address: | 2480 White Bear Ave N Ste 202 Maplewood |
| State: | MN US |
| Postal Code: | 551094567 |
| Phone Number: | 6517777744 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 03/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D13349 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |