Healthcare Provider Details

I. General information

NPI: 1538264874
Provider Name (Legal Business Name): OWATONNA DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S OAK AVE SUITE 5
OWATONNA MN
55060-3900
US

IV. Provider business mailing address

1414 S OAK AVE SUITE 5
OWATONNA MN
55060-3900
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2226
  • Fax: 507-455-9224
Mailing address:
  • Phone: 507-451-2226
  • Fax: 507-455-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARGARET ANN TRILK
Title or Position: OFFICE MANAGER
Credential:
Phone: 507-451-2226