MEDICARE: NORTH BENTON DENTAL CARE

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	1223G0001X	General Practice Dentistry	D7468	MN
2	1223G0001X	General Practice Dentistry	D11796	MN
3	1223G0001X	General Practice Dentistry	D10858	MN

General Provider Information

NPI Number	:	1700815008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BENTON DENTAL CARE

Provider Business Mailing Address
First Line	:	400 N BENTON DR
Second Line	:
City	:	SAUK RAPIDS
State	:	MN
Zip	:	56379-1535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N BENTON DR
Second Line	:
City	:	SAUK RAPIDS
State	:	MN
Zip	:	56379-1535
Country	:	US
Telephone Number	:	320-253-4206
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAMELA JANE POGANSKI
Credential	:
Telephone Number	:	320-253-4206

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	08/22/2020

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Directions to “NORTH BENTON DENTAL CARE ” Practice Location

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