Healthcare Provider Details

I. General information

NPI: 1427260520
Provider Name (Legal Business Name): LONSDALE FAMILY DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 RAILWAY ST NW
LONSDALE MN
55046-9661
US

IV. Provider business mailing address

414 RAILWAY ST NW PO BOX 110
LONSDALE MN
55046-9661
US

V. Phone/Fax

Practice location:
  • Phone: 507-744-2359
  • Fax:
Mailing address:
  • Phone: 507-744-2359
  • Fax:

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: DR. JOHN ROSS HINER
Title or Position: CO-OWNER
Credential: DDS
Phone: 507-744-2359