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General NPI Number Information
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NPI Number | 1386198729
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Entity Type | Organization
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Legal Business Name | SMILES AROUND MINNESOTA
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 08/14/2016
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Provider Practice Location Address
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Address Line | 842 BALSAM CT NE
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City | PINE ISLAND
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State | MN
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Zip | 55963-7634
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Country | US
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Telephone | 507-923-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 842 BALSAM CT NE
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City | PINE ISLAND
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State | MN
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Zip | 55963-7634
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DENTAL HYGIENIST
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Name | SHELDON LAS
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Credential |
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Telephone | 507-923-7235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6244
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License Number State | MN
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