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Organization

F C REQUA DDS PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FREDERICK C REQUA DDS (PRES)
(507) 433-1641
Entity
Organization

Contact information

Practice address
400 3RD AVE NW, AUSTIN, MN 55912
(507) 433-1641
Mailing address
400 3RD AVE NW, AUSTIN, MN 55912
(507) 433-1641

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6155
MN

Other

Enumeration date
10/25/2006
Last updated
08/22/2020
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