MEDICARE: DR. DOUGLAS VOSE D.D.S.

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	10220	MN

General Provider Information

NPI Number	:	1720124407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS VOSE D.D.S.

Provider Business Mailing Address
First Line	:	220 E MAIN ST
Second Line	:	SUITE 210
City	:	MANKATO
State	:	MN
Zip	:	56001-3574
Country	:	US
Telephone Number	:	507-387-2255
Fax Number	:	507-387-2255

Provider Business Practice Location Address
First Line	:	220 E MAIN ST
Second Line	:	SUITE 210
City	:	MANKATO
State	:	MN
Zip	:	56001-3574
Country	:	US
Telephone Number	:	507-387-2255
Fax Number	:	507-387-2255

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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