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General NPI Number Information
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NPI Number | 1003636911
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Entity Type | Organization
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Legal Business Name | SOUTHERN MINNESOTA SLEEP CENTER, PLLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 170 LANDMARK DR NE STE A
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City | OWATONNA
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State | MN
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Zip | 55060-1590
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Country | US
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Telephone | 612-501-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 110 1ST ST N
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City | MONTGOMERY
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State | MN
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Zip | 56069-1514
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Country | US
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Telephone | 612-501-1577
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Fax |
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Authorized Official
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Title or Position | DENTIST/CEO
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Name | KURT DANIEL ERICKSON
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Credential | DDS
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Telephone | 612-501-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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