Healthcare Provider Details

I. General information

NPI: 1437340817
Provider Name (Legal Business Name): MARIE ANN MUESKE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1350 N 7TH ST
LAKE CITY MN
55041-1251
US

IV. Provider business mailing address

1350 N 7TH ST
LAKE CITY MN
55041-1251
US

V. Phone/Fax

Practice location:
  • Phone: 651-345-3023
  • Fax:
Mailing address:
  • Phone: 651-345-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12462
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: