Healthcare Provider Details

I. General information

NPI: 1992399224
Provider Name (Legal Business Name): LUVERNE FAMILY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
LUVERNE MN
56156-1830
US

IV. Provider business mailing address

115 E MAIN ST
LUVERNE MN
56156-1830
US

V. Phone/Fax

Practice location:
  • Phone: 507-283-9129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW P FORD
Title or Position: OWNER
Credential: DMD
Phone: 320-247-0953