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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