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General NPI Number Information
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NPI Number | 1598145419
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Entity Type | Organization
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Legal Business Name | MILACA FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 1015 5TH ST SE
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City | MILACA
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State | MN
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Zip | 56353
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Country | US
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Telephone | 320-983-6600
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Fax | 320-983-3699
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | MILACA
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State | MN
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Zip | 56353
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Country | US
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Telephone | 320-983-6600
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Fax | 320-983-3699
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Authorized Official
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Title or Position | DENTIST/OWNER/PRESIDENT
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Name | NICHOLAS SCHUETT
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Credential | DDS
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Telephone | 320-983-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D13070
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License Number State | MN
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