Healthcare Provider Details

I. General information

NPI: 1477564219
Provider Name (Legal Business Name): DENTAL CARE ASSOCIATES OF BUFFALO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BRIGHTON AVE S
BUFFALO MN
55313-2318
US

IV. Provider business mailing address

306 BRIGHTON AVE S
BUFFALO MN
55313-2318
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-2572
  • Fax: 763-682-2700
Mailing address:
  • Phone: 763-360-9972
  • Fax: 763-682-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LISA MARIE SPIER
Title or Position: OWNER
Credential: DDS
Phone: 763-682-2572