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General NPI Number Information
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NPI Number | 1720484496
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Entity Type | Organization
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Legal Business Name | ROOT RIVER DENTAL, PA
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 100 2ND ST SE
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City | STEWARTVILLE
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State | MN
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Zip | 55976-1288
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Country | US
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Telephone | 507-533-7735
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Fax | 507-533-8852
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | STEWARTVILLE
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State | MN
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Zip | 55976-0008
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Country | US
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Telephone | 507-533-7735
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Fax | 507-533-8852
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Authorized Official
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Title or Position | OWNER/SHAREHOLDER
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Name | ZACHARY J LECHNER
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Credential | DDS
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Telephone | 320-493-0424
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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 | D45964
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License Number State | MN
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