Organization
HANCOCK DENTAL CLINIC, PA
Active
Other names
Hancock and Chokio Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J CARLSON D.D.S. (OWNER/PRESIDENT)
(320) 392-5300
Entity
Organization
Contact information
Practice address
657 ATLANTIC AVE, HANCOCK, MN 56244-2104
(320) 392-5300
(320) 392-5302
Mailing address
657 ATLANTIC AVE, PO BOX 395, HANCOCK, MN 56244-2104
(320) 392-5300
(320) 392-5302
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10212
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306931720
NPI
MN
Enumeration date
03/22/2016
Last updated
03/22/2016
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