Organization
MAIN STREET DENTAL CLINIC OF MANKATO, PLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD MICHAEL HANSON DDS (CFO)
(507) 583-2141
Entity
Organization
Contact information
Practice address
287 ST ANDREWS DRIVE, 100, MANKATO, MN 56001
(507) 720-0250
Mailing address
287 ST ANDREWS DRIVE, 100, MANKATO, MN 56001-8584
(507) 720-0250
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12942
MN
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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