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General NPI Number Information
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NPI Number | 1649590829
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Entity Type | Organization
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Legal Business Name | DR. DENNIS L. NIERENGARTEN, D.D.S., P.A.
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 1511 NORTHWAY DR STE 102
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1262
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Country | US
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Telephone | 320-255-1020
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Fax | 320-255-1020
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Provider Business Mailing Address
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Address Line | 1511 NORTHWAY DR STE 102
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1262
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Country | US
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Telephone | 320-255-1020
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Fax | 320-255-1020
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DENNIS LEE NIERENGARTEN
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Credential | D.D.S., P.A.
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Telephone | 320-255-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | D9004
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License Number State | MN
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