Healthcare Provider Details

I. General information

NPI: 1851456065
Provider Name (Legal Business Name): NEMETH ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 N 12TH ST
ST. CLOUD MN
56303
US

IV. Provider business mailing address

3131 N 12TH ST
ST. CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-4981
  • Fax: 320-253-6268
Mailing address:
  • Phone: 320-253-4981
  • Fax: 320-253-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11250
License Number StateMN

VIII. Authorized Official

Name: DR. BENJAMIN R. NEMETH
Title or Position: ORTHODONTIST
Credential: DDS, MSC
Phone: 320-253-4981