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Contact Information

4TH AVENUE DENTAL, PA, DBA OAK PARK DENTAL
505 JOHNSON AVE SE
PINE CITY, MN55063-2108
 Phone: 320-629-2282
 Fax: 320-629-3357
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for 4TH AVENUE DENTAL PA DBA OAK PARK DENTAL · (Female)

NPI Number 1609298355
Status Active
Credentials
Entity Individual
Enumeration date 01/15/2014
Last updated 01/15/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • MN License # D11935
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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