Healthcare Provider Details

I. General information

NPI: 1346301454
Provider Name (Legal Business Name): APPLE TREE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MAIN STREET
HAWLEY MN
56549-0849
US

IV. Provider business mailing address

2201 26TH AVE NW
NEW BRIGHTON MN
55112-5005
US

V. Phone/Fax

Practice location:
  • Phone: 218-483-1038
  • Fax: 218-483-1339
Mailing address:
  • Phone: 763-784-7993
  • Fax: 763-784-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NANCY SCHUMACHER
Title or Position: CFO
Credential:
Phone: 763-784-7993