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General NPI Number Information
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NPI Number | 1225258247
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH SERVICES MINNEWASKA PLLC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1616 N FRANKLIN STR
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City | GLENWOOD
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State | MN
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Zip | 56334
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Country | US
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Telephone | 320-634-3556
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Fax | 320-634-3567
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Provider Business Mailing Address
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Address Line | PO BOX 213 1616 N FRANKLIN STR
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City | GLENWOOD
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State | MN
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Zip | 56334
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Country | US
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Telephone | 320-634-3556
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Fax | 320-634-3567
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Authorized Official
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Title or Position | OWNER W DR JEREMY MYROM
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Name | MR. SCOTT WILLIAM RINGDAHL
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Credential | DDS
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Telephone | 320-634-3556
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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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