Organization Name: | 6460 DENTAL, PA |
NPI Number: | 1790181337 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SARAH M BURT (OPERATIONS DIRECTOR) |
Mailing Address: | 6460 Main St North Branch |
State: | MN US |
Postal Code: | 550567068 |
Phone Number: | 6516747096 |
Fax Number: | 6512037373 |
NPI Enumeration Date: | 11/10/2014 |
NPI Last Update Date: | 11/10/2014 |
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: |