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Organization
HER AND MAN TOWN DENTAL PLLC
Active
Organization
HER AND MAN TOWN DENTAL PLLC
Active
Other names
Boulder Trail Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY MAKITALO (INSURANCE COORDINATOR)
(218) 722-2428
Entity
Organization
Contact information
Practice address
4135 RICHARD AVE STE 103, HERMANTOWN, MN 55811-2979
(218) 722-2428
(218) 722-0142
Mailing address
4135 RICHARD AVE STE 103, HERMANTOWN, MN 55811-2979
(218) 722-2428
(218) 722-0142
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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