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General NPI Number Information
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NPI Number | 1609485432
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Entity Type | Organization
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Legal Business Name | AMETHYST DENTAL CARE LLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 1751 HIGHWAY 52 N
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City | ROCHESTER
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State | MN
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Zip | 55901-1692
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Country | US
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Telephone | 507-282-9288
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Fax | 507-292-6622
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Provider Business Mailing Address
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Address Line | 1751 HIGHWAY 52 N
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City | ROCHESTER
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State | MN
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Zip | 55901-1692
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Country | US
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Telephone | 507-282-9288
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Fax | 507-292-6622
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JOHN C. BOEKER
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Credential | DDS
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Telephone | 507-288-9288
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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 |
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License Number State |
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