Provider Demographics
NPI:1538303698
Name:KALINOFF, FRED P (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:P
Last Name:KALINOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 ANNE ST NW
Mailing Address - Street 2:C/O NORTHERN DENTAL ACCESS CENTER
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5113
Mailing Address - Country:US
Mailing Address - Phone:218-444-9646
Mailing Address - Fax:218-444-9252
Practice Address - Street 1:1405 ANNE ST NW
Practice Address - Street 2:C/O NORTHERN DENTAL ACCESS CENTER
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5113
Practice Address - Country:US
Practice Address - Phone:218-444-9646
Practice Address - Fax:218-444-9252
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist