Healthcare Provider Details

I. General information

NPI: 1871726331
Provider Name (Legal Business Name): ESTHETIC FAMILY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GREENWOOD AVE
HECTOR MN
55342
US

IV. Provider business mailing address

PO BOX 547
HECTOR MN
55342-0547
US

V. Phone/Fax

Practice location:
  • Phone: 320-848-2611
  • Fax:
Mailing address:
  • Phone: 320-848-2611
  • 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: DR. DANIEL H MENSER
Title or Position: OWNER
Credential: DDS
Phone: 320-848-2611