| Distinctive Dental Services, Pa | |
|
612 8th Ave # 664 Howard Lake MN 55349-5137 | |
| (320) 543-2233 | |
| (320) 543-2368 |
| Full Name | Distinctive Dental Services, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 612 8th Ave # 664, Howard Lake, Minnesota |
| Authorized Official Name and Position | Michael John Thoennes (CEO) |
| Authorized Official Contact | 3204854344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Distinctive Dental Services, Pa 612 8th Ave # 664 Howard Lake MN 55349-5137 Ph: (320) 543-2233 | Distinctive Dental Services, Pa 612 8th Ave # 664 Howard Lake MN 55349-5137 Ph: (320) 543-2233 |
| NPI Number | 1073780805 |
|---|---|
| Provider Enumeration Date | 05/12/2008 |
| Last Update Date | 05/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073780805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D08971 (Minnesota) | Primary |
Luce Line Family Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 612 8th Ave, Howard Lake, MN 55349 Phone: 320-583-4369 |