Healthcare Provider Details

I. General information

NPI: 1922346907
Provider Name (Legal Business Name): SHELLEY LYNN SPERLING BS,RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N BROADWAY SUITE B
ROCHESTER MN
55906-3728
US

IV. Provider business mailing address

6910 BUCKTHORN DR NW
ROCHESTER MN
55901-8832
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-4100
  • Fax:
Mailing address:
  • Phone: 507-269-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH3635
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: