MEDICARE: WHITE OAK DENTAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548003270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE OAK DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1475 WHITE OAK DR STE 200
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2945
Country	:	US
Telephone Number	:	952-448-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 WHITE OAK DR STE 200
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2945
Country	:	US
Telephone Number	:	952-448-2868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	APRIL KORTE
Credential	:	DMD
Telephone Number	:	320-333-9793

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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