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General NPI Number Information
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NPI Number | 1255491866
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Entity Type | Organization
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Legal Business Name | INTEGRITY DENTAL CARE, P.A.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 7500 80TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016
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Country | US
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Telephone | 651-459-3039
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Fax | 651-459-9874
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Provider Business Mailing Address
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Address Line | 7500 80TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016
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Country | US
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Telephone | 651-459-3039
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Fax | 651-459-9874
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | RICHARD P TREHARNE
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Credential | DDS
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Telephone | 651-459-3039
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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 | 8108
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10522
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10404
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License Number State | MN
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