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General NPI Number Information
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NPI Number | 1972636777
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Entity Type | Organization
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Legal Business Name | FAMILY DENTIST TREE, PA
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 1011 BEL AIR LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-6992
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Country | US
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Telephone | 507-288-1188
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Fax | 507-529-4065
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Provider Business Mailing Address
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Address Line | 1011 BEL AIR LN NW
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City | ROCHESTER
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State | MN
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Zip | 55901-6992
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Country | US
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Telephone | 507-288-1188
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Fax | 507-529-4065
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARIE SAMUELSON
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Credential |
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Telephone | 507-288-1188
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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 |
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License Number State |
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