MEDICARE: CAREY P TRI DDS

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	D12385	MN

General Provider Information

NPI Number	:	1578769014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAREY P TRI DDS

Provider Business Mailing Address
First Line	:	1260 HWY 55
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2359
Country	:	US
Telephone Number	:	651-437-1940
Fax Number	:	651-437-9333

Provider Business Practice Location Address
First Line	:	1260 HWY 55
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2359
Country	:	US
Telephone Number	:	651-437-1940
Fax Number	:	651-437-9333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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