Organization
CRYSTAL DENTAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE THEEDE (OFFICE MANAGER)
(507) 208-4141
Entity
Organization
Contact information
Practice address
1812 2ND ST SW, ROCHESTER, MN 55902-4127
(507) 208-4141
(507) 229-1001
Mailing address
1812 2ND ST SW, ROCHESTER, MN 55902-4127
(507) 208-4141
(507) 229-1001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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