Organization
LONE OAK FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS AMMEN HANEL (DENTIST)
(218) 745-4601
Entity
Organization
Contact information
Practice address
205 W JOHNSON AVE, STE. 3, WARREN, MN 56762-1118
(218) 745-4601
(218) 745-4600
Mailing address
205 W JOHNSON AVE, STE. 3, WARREN, MN 56762-1118
(218) 745-4601
(218) 745-4600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12024
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473990600
—
MN
Enumeration date
04/01/2014
Last updated
04/01/2014
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