Organization
THE SALVATION ARMY
Active
Other names
The Salvation Army Good Samaritan Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON UTHKE-SCALETTA DELEGATED OFFICIAL (GOVERNMENT GRANTWRITER)
(651) 746-3543
Entity
Organization
Contact information
Practice address
120 N BROADWAY STE B, ROCHESTER, MN 55906-3728
(507) 529-4100
(507) 529-4101
Mailing address
20 1ST AVE NE, ROCHESTER, MN 55906-3706
(507) 529-4100
(507) 529-4101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
867910000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
867910000
PROVIDER IDENTIFICATION #
MN
Enumeration date
11/29/2006
Last updated
12/02/2019
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