Healthcare Provider Details

I. General information

NPI: 1316519028
Provider Name (Legal Business Name): PINE CITY FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 HILLSIDE AVE SW
PINE CITY MN
55063-2153
US

IV. Provider business mailing address

205 OPPORTUNITY BLVD N
CAMBRIDGE MN
55008-5823
US

V. Phone/Fax

Practice location:
  • Phone: 320-629-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM CURTIS
Title or Position: OWNER
Credential: DDS
Phone: 651-470-9590