NPI 1447956875

State of Minnesota Minnesota Management and Budget

Organisation General Practice Dentistry Fergus Falls, MN

Practice location

Address: 1821 N. Park Street, Fergus Falls, MN 56537-1247
Phone: (218) 736-0400
Fax: (612) 548-5964
Mailing address: 5101 Minnehaha Ave. S, Minneapolis, MN 55417-1647

Authorised official

Name: Simone Renee Hogan
Title: Mdva Chief Operations Director
Phone: (612) 505-4110

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X

Other Dentist providers in Minnesota →

Registry record

NPI: 1447956875
Entity type: Organization
NPI issued: 7 Feb 2023
Record last updated: 3 Dec 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.