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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

NPI Number 1609298355
LBN Legal business name 4TH AVENUE DENTAL, PA, DBA OAK PARK DENTAL
Authorized official ALICIA ASCHEMAN - (SUPERVISOR/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/15/2014
Last updated 01/15/2014 - About 12 years ago
Identifiers
MN License # D11935
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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