Healthcare Provider Details

I. General information

NPI: 1811356306
Provider Name (Legal Business Name): DRYTECH CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13483 FENWAY BLVD CIRCLE NO.
HUGO MN
55038
US

IV. Provider business mailing address

13483 FENWAY BLVD CIRCLE NO.
HUGO MN
55038
US

V. Phone/Fax

Practice location:
  • Phone: 651-429-8444
  • Fax: 651-429-8451
Mailing address:
  • Phone: 651-429-8444
  • Fax: 651-429-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL GEORGE PEDERSON
Title or Position: CEO
Credential:
Phone: 651-429-8444