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General NPI Number Information
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NPI Number | 1700209194
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Entity Type | Organization
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Legal Business Name | BLUE SKY DENTAL, PLLC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 18 3RD ST SW SUITE 300
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City | ROCHESTER
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State | MN
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Zip | 55902-3024
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Country | US
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Telephone | 507-258-5260
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Fax | 815-346-3307
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Provider Business Mailing Address
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Address Line | 18 3RD ST SW SUITE 300
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City | ROCHESTER
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State | MN
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Zip | 55902-3024
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Country | US
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Telephone | 507-258-5260
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SONJA MAE LANGTON-YANOWITZ
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Credential | D.D.S.
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Telephone | 507-258-5260
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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 | D12797
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License Number State | MN
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