=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629819222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAILER FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2024
-----------------------------------------------------
Last Update Date | 06/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ROOSEVELT AVE
-----------------------------------------------------
City | DETROIT LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56501-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-847-8765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44509 E LITTLE MCDONALD DR
-----------------------------------------------------
City | PERHAM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56573-8640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-535-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | DR. LUKE M SAILER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 218-535-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------