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General NPI Number Information
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NPI Number | 1093607764
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Entity Type | Organization
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Legal Business Name | PLUM TREE DENTAL
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 202 S 5TH AVE
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City | VIRGINIA
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State | MN
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Zip | 55792-2638
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Country | US
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Telephone | 218-749-1776
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Fax | 218-749-0866
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Provider Business Mailing Address
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Address Line | 202 S 5TH AVE
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City | VIRGINIA
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State | MN
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Zip | 55792-2638
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Country | US
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Telephone | 218-749-1776
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Fax | 218-749-0866
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | CLARISSA SPARKMAN
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Credential | DMD
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Telephone | 218-749-1776
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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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