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General NPI Number Information
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NPI Number | 1275797763
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Entity Type | Organization
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Legal Business Name | BYRON ROWELL PA
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 510 NW 2ND AVE
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2627
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Country | US
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Telephone | 218-326-1266
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Fax | 218-326-9502
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Provider Business Mailing Address
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Address Line | 510 NW 2ND AVE
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2627
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Country | US
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Telephone | 218-326-1266
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Fax | 218-326-9502
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MR. BYRON G ROWELL
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Credential | D.D.S.
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Telephone | 218-326-1266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8282
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License Number State | MN
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