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General NPI Number Information
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NPI Number | 1427455062
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Entity Type | Organization
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Legal Business Name | SHETEK DENTAL CARE PA
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 106 2ND ST NW
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City | FULDA
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State | MN
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Zip | 56131
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Country | US
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Telephone | 507-425-2276
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Fax | 507-425-2769
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Provider Business Mailing Address
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Address Line | 106 2ND ST NW
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City | FULDA
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State | MN
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Zip | 56131-1101
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Country | US
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Telephone | 507-425-2276
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Fax | 507-425-2769
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MS. NARLA NORINE HULSTEIN
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Credential | CDA, RDA
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Telephone | 507-836-1000
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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 | 12229
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8209
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License Number State | MN
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