| Hanover Dental Pllc | |
| 
					411 Labeaux Ave Ne Hanover MN 55341  | |
| (763) 400-3005 | |
| Not Available | 
| Full Name | Hanover Dental Pllc | 
|---|---|
| Speciality | Clinic/center - Dental | 
| Location | 411 Labeaux Ave Ne, Hanover, Minnesota | 
| Authorized Official Name and Position | Tyler James Koivisto (DENTIST) | 
| Authorized Official Contact | 7632267379 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Hanover Dental Pllc 1192 Bice Ave Nw Buffalo MN 55313-4456 Ph: (763) 226-7379  | Hanover Dental Pllc 411 Labeaux Ave Ne Hanover MN 55341 Ph: (763) 400-3005  | 
| NPI Number | 1487147260 | 
|---|---|
| Provider Enumeration Date | 06/07/2018 | 
| Last Update Date | 06/07/2018 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1487147260 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D13236 (Minnesota) | Primary |