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General NPI Number Information
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NPI Number | 1326156910
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Entity Type | Organization
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Legal Business Name | ECKART DENTAL CENTER LLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1444
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Country | US
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Telephone | 952-445-1352
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Fax | 952-445-7221
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Provider Business Mailing Address
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Address Line | 300 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1444
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Country | US
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Telephone | 952-445-1352
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Fax | 952-445-7221
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA M. KREUSER
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Credential |
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Telephone | 952-445-1352
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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 | 9527
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License Number State | MN
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