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General NPI Number Information
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NPI Number | 1417327701
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Entity Type | Organization
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Legal Business Name | REFLECTIONS FAMILY DENTAL
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 512 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3232
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Country | US
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Telephone | 320-235-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 512 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3232
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Country | US
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Telephone | 320-235-2551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABBIE KERSHNER
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Credential |
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Telephone | 320-235-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D13613
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License Number State | MN
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