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General NPI Number Information
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NPI Number | 1740005354
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Entity Type | Organization
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Legal Business Name | HUGO DENTAL CARE PLLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 5677 147TH ST N
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City | HUGO
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State | MN
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Zip | 55038-9302
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Country | US
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Telephone | 320-217-9940
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Fax |
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Provider Business Mailing Address
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Address Line | 15895 YELLOW PINE ST NW
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City | ANDOVER
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State | MN
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Zip | 55304-4596
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Country | US
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Telephone | 320-217-9940
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARI LIESTMAN
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Credential | DDS
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Telephone | 320-217-9940
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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 |
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License Number State |
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