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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1477527836

Individual Registrant:
Gender: M

Location and contact information for practice:
159 18TH ST SW  OWATONNA, MN 55060-3981 US
Tel: 507-455-1000  Fax: 507-444-9423

Contact information for business:
159 18TH ST SW  OWATONNA, MN 55060-3981 US
Tel: 507-455-1000  Fax: 507-444-9423

Registration Information:
NPI: 1477527836
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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