| 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 |