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General NPI Number Information
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NPI Number | 1215042445
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Entity Type | Organization
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Legal Business Name | ST PETER FAMILY DENTAL CENTER, P.A.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 402 SUNRISE DR
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City | SAINT PETER
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State | MN
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Zip | 56082-1342
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Country | US
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Telephone | 507-931-1230
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Fax | 507-931-1493
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Provider Business Mailing Address
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Address Line | 402 SUNRISE DR
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City | SAINT PETER
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State | MN
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Zip | 56082-1342
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Country | US
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Telephone | 507-931-1230
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Fax | 507-931-1493
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK E CONOVER
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Credential |
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Telephone | 507-931-1230
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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 | MN
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