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Organization
TLA DDS PLLC
Active
Organization
TLA DDS PLLC
Active
Other names
Renu Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TIARA APPLEQUIST DDS (OWNER)
(218) 281-1301
Entity
Organization
Contact information
Practice address
2211 SAHLSTROM DR STE A, CROOKSTON, MN 56716-2827
(218) 281-1301
Mailing address
2211 SAHLSTROM DR STE A, CROOKSTON, MN 56716-2827
(218) 281-1301
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
05/20/2022
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