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General NPI Number Information
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NPI Number | 1114333986
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Entity Type | Organization
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Legal Business Name | DRESEN RESTORATIVE DENTISTRY, PA
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 6936 PINE ARBOR DR S SUITE 210
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4645
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Country | US
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Telephone | 651-735-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 6936 PINE ARBOR DR S SUITE 210
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4645
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Country | US
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Telephone | 651-735-1585
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS MATTHEW DRESEN
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Credential | DDS
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Telephone | 651-735-1585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10827
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License Number State | MN
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