Healthcare Provider Details

I. General information

NPI: 1497115232
Provider Name (Legal Business Name): APPLETON DENTAL CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2016
Last Update Date: 03/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 S BEHL ST
APPLETON MN
56208-1616
US

IV. Provider business mailing address

32 S BEHL ST
APPLETON MN
56208-1616
US

V. Phone/Fax

Practice location:
  • Phone: 320-289-2241
  • Fax:
Mailing address:
  • Phone: 320-289-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD13010
License Number StateMN

VIII. Authorized Official

Name: DR. PAUL M CARLSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 320-289-2241