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General NPI Number Information
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NPI Number | 1790822690
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Entity Type | Organization
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Legal Business Name | HASTINGS DENTAL ASSOCIATES
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 6TH ST W
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City | HASTINGS
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State | MN
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Zip | 55033-1801
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Country | US
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Telephone | 651-437-9812
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Fax | 651-480-3404
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Provider Business Mailing Address
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Address Line | 106 6TH ST W
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City | HASTINGS
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State | MN
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Zip | 55033-1801
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Country | US
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Telephone | 651-437-9812
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Fax | 651-480-3404
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | MS. BRENDA J BUCK
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Credential |
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Telephone | 651-437-9812
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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 | 8822
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License Number State | MN
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