| Open Door Health Center - Mobile Dental | |
|
309 Holly Ln Mankato MN 56001-5422 | |
| (507) 388-2120 | |
| (507) 388-3924 |
| Full Name | Open Door Health Center - Mobile Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 309 Holly Ln, Mankato, Minnesota |
| Authorized Official Name and Position | Douglas L Jaeger (CEO) |
| Authorized Official Contact | 5073445500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Door Health Center - Mobile Dental 309 Holly Ln Mankato MN 56001-5422 Ph: (507) 388-2120 | Open Door Health Center - Mobile Dental 309 Holly Ln Mankato MN 56001-5422 Ph: (507) 388-2120 |
| NPI Number | 1356611404 |
|---|---|
| Provider Enumeration Date | 01/06/2012 |
| Last Update Date | 04/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356611404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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