Healthcare Provider Details

I. General information

NPI: 1457888463
Provider Name (Legal Business Name): CANAAN MUSCATELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 CENTER AVE W
DILWORTH MN
56529-1339
US

IV. Provider business mailing address

1965 CLIFF LAKE RD STE 102
EAGAN MN
55122
US

V. Phone/Fax

Practice location:
  • Phone: 218-287-2938
  • Fax:
Mailing address:
  • Phone: 651-452-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD13824
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: