Healthcare Provider Details

I. General information

NPI: 1558470179
Provider Name (Legal Business Name): MARIANNA DANELICH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CENTRAL AVE
OSSEO MN
55369-1241
US

IV. Provider business mailing address

40 CENTRAL AVE
OSSEO MN
55369-1241
US

V. Phone/Fax

Practice location:
  • Phone: 763-425-3023
  • Fax: 763-425-8450
Mailing address:
  • Phone: 763-425-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12252
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: