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General NPI Number Information
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NPI Number | 1508280009
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Entity Type | Organization
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Legal Business Name | FIEDLER DENTISTRY, PA
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 115 OLSEN BLVD NE STE 200
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City | COKATO
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State | MN
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Zip | 55321-4797
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Country | US
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Telephone | 320-286-2712
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Fax |
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Provider Business Mailing Address
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Address Line | 115 OLSEN BLVD NE STE 200 PO BOX 548
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City | COKATO
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State | MN
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Zip | 55321-4797
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Country | US
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Telephone | 320-286-2712
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK M FIEDLER
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Credential | D.D.S.
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Telephone | 320-286-2712
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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 | D12373
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License Number State | MN
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