Healthcare Provider Details

I. General information

NPI: 1518550078
Provider Name (Legal Business Name): CANNON FALLS FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MAIN ST W
CANNON FALLS MN
55009-2074
US

IV. Provider business mailing address

411 MAIN ST W
CANNON FALLS MN
55009-2074
US

V. Phone/Fax

Practice location:
  • Phone: 507-263-2411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ADAM CURTIS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 651-470-9590