Healthcare Provider Details

I. General information

NPI: 1427455062
Provider Name (Legal Business Name): SHETEK DENTAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 2ND ST NW
FULDA MN
56131
US

IV. Provider business mailing address

106 2ND ST NW
FULDA MN
56131-1101
US

V. Phone/Fax

Practice location:
  • Phone: 507-425-2276
  • Fax: 507-425-2769
Mailing address:
  • Phone: 507-425-2276
  • Fax: 507-425-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12229
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8209
License Number StateMN

VIII. Authorized Official

Name: MS. NARLA NORINE HULSTEIN
Title or Position: CLINIC MANAGER
Credential: CDA, RDA
Phone: 507-836-1000