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General NPI Number Information
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NPI Number | 1275189607
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Entity Type | Organization
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Legal Business Name | BLUESTEM DENTAL PLLC
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 210 13TH ST S
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City | BENSON
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State | MN
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Zip | 56215-1821
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Country | US
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Telephone | 320-842-4191
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Fax | 320-843-4208
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Provider Business Mailing Address
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Address Line | 33494 290TH AVE
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City | BENSON
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State | MN
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Zip | 56215-3102
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Country | US
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Telephone | 320-444-4033
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Fax | 320-843-4208
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Authorized Official
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Title or Position | ORGANIZING MEMBER
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Name | DR. ANTHONY JAMES HILLEREN
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Credential | DDS
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Telephone | 320-842-4191
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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 |
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License Number State |
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