| 4th Avenue Dental, Pa, Dba Oak Park Dental | |
|
505 Johnson Ave Se Pine City MN 55063-2108 | |
| (320) 629-2282 | |
| (320) 629-3357 |
| Full Name | 4th Avenue Dental, Pa, Dba Oak Park Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 505 Johnson Ave Se, Pine City, Minnesota |
| Authorized Official Name and Position | Alicia Ascheman (SUPERVISOR/OWNER) |
| Authorized Official Contact | 3206292282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 4th Avenue Dental, Pa, Dba Oak Park Dental 505 Johnson Ave Se Pine City MN 55063-2108 Ph: (320) 629-2282 | 4th Avenue Dental, Pa, Dba Oak Park Dental 505 Johnson Ave Se Pine City MN 55063-2108 Ph: (320) 629-2282 |
| NPI Number | 1609298355 |
|---|---|
| Provider Enumeration Date | 01/15/2014 |
| Last Update Date | 01/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609298355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D11935 (Minnesota) | Primary |
Oak Park Dental - Pine City Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 Johnson Ave Se, Pine City, MN 55063 Phone: 320-629-2282 | |
Oak Park Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 Johnson Ave Se, Pine City, MN 55063 Phone: 320-629-2282 Fax: 320-629-3357 |