| Organization Name: | DISTINCTIVE DENTAL SERVICES, PA |
| NPI Number: | 1457571952 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL JOHN THOENNES (CEO) |
| Mailing Address: | 131 Main Ave W Winsted |
| State: | MN US |
| Postal Code: | 553957873 |
| Phone Number: | 3204854344 |
| Fax Number: | 3204854734 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |