Healthcare Provider Details

I. General information

NPI: 1114076619
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN AND ADOLESCENTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 SUPERIOR DR NW
ROCHESTER MN
55901-1773
US

IV. Provider business mailing address

2743 SUPERIOR DR NW
ROCHESTER MN
55901-1773
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-8060
  • Fax: 507-288-3344
Mailing address:
  • Phone: 507-288-8060
  • Fax: 507-288-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBYN RENE LOEWEN
Title or Position: DENTIST
Credential: D.D.S.
Phone: 507-288-8060