Healthcare Provider Details

I. General information

NPI: 1427107721
Provider Name (Legal Business Name): G E MAHER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FIRST AVENUE SW
GLENWOOD MN
56334
US

IV. Provider business mailing address

BOX 174 101 FIRST AVENUE SW
GLENWOOD MN
56334
US

V. Phone/Fax

Practice location:
  • Phone: 320-634-4543
  • Fax: 320-634-4544
Mailing address:
  • Phone: 320-634-4543
  • Fax: 320-634-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7325
License Number StateMN

VIII. Authorized Official

Name: DR. GERALD EDWARD MAHER
Title or Position: PRESIDENT OWNER
Credential: BS DDS
Phone: 320-634-4543