Organization
AVON DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLETTE THERESE PORTTIIN DDS (PRESIDENT)
(952) 686-8444
Entity
Organization
Contact information
Practice address
308A BLATTNER DR, AVON, MN 56310-8674
(320) 356-7374
Mailing address
24183 69TH AVE, SAINT AUGUSTA, MN 56301-8402
(952) 686-8444
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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