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Contact Information

MAIN STREET DENTAL CLINIC OF MANKATO, PLLP
287 ST ANDREWS DRIVE
100
MANKATO, MN56001
 Phone: 507-720-0250
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for MAIN STREET DENTAL CLINIC OF MANKATO, PLLP

NPI Number 1285032243
LBN Legal business name MAIN STREET DENTAL CLINIC OF MANKATO, PLLP
Authorized official CHAD HANSON - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 12/08/2014
Last updated 12/08/2014 - About 11 years ago
Identifiers
MN License # 12942
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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