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General NPI Number Information
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NPI Number | 1811033061
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Entity Type | Organization
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Legal Business Name | WILLMAR DENTAL CLINIC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 1801 TECHNOLOGY DR NE
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-231-5100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64979
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City | SAINT PAUL
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State | MN
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Zip | 55164-0979
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HUMAN SERVICE MANAGER
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Name | VICTORIA O ALABI
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Credential |
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Telephone | 651-478-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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