MEDICARE: SANDSTONE DENTAL OFFICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8046	MN

General Provider Information

NPI Number	:	1053427237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDSTONE DENTAL OFFICE

Provider Business Mailing Address
First Line	:	501 N COMMERCIAL AVE
Second Line	:	PO BOX 589
City	:	SANDSTONE
State	:	MN
Zip	:	55072-0589
Country	:	US
Telephone Number	:	320-245-2208
Fax Number	:	320-245-2208

Provider Business Practice Location Address
First Line	:	501 N COMMERCIAL AVE
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-0589
Country	:	US
Telephone Number	:	320-245-2208
Fax Number	:	320-245-2208

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. MICHAEL MAURICE BENNETT
Credential	:	DDS
Telephone Number	:	320-245-2208

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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Directions to “SANDSTONE DENTAL OFFICE ” Practice Location

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