Organization Name: | ESTHETIC FAMILY DENTISTRY PC |
NPI Number: | 1871726331 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL H MENSER (OWNER) |
Mailing Address: | 150 Greenwood Ave Hector |
State: | MN US |
Postal Code: | 55342 |
Phone Number: | 3208482611 |
Fax Number: | |
NPI Enumeration Date: | 09/01/2009 |
NPI Last Update Date: | 09/01/2009 |
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: |