Organization
MAPLE STREET, PC
Active
Other names
Houston Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN W EVENSON D.D.S. (OWNER)
(507) 896-2202
Entity
Organization
Contact information
Practice address
109 E MAPLE ST, HOUSTON, MN 55943-8449
(507) 896-2202
Mailing address
109 E MAPLE ST, HOUSTON, MN 55943-8449
(507) 896-2202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11269
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
459846600
—
MN
Enumeration date
07/20/2009
Last updated
07/20/2009
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