Organization Name: | CHRISTOPHER MERTENSOTTO DDS, PLLC |
NPI Number: | 1558612887 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTOPHER PAUL MERTENSOTTO (DENTIST/OWNER) |
Mailing Address: | 1716 2nd Ave N Sauk Rapids |
State: | MN US |
Postal Code: | 563792756 |
Phone Number: | 3206549999 |
Fax Number: | 3202402319 |
NPI Enumeration Date: | 09/26/2012 |
NPI Last Update Date: | 09/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D12157 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |