Organization
LONE OAK FAMILY DENTISTRY
Active
Parent organization
KITTSON DENTAL CLINIC, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
KITTSON DENTAL CLINIC, PA
Authorized official
TRAVIS HANEL DDS (OWNER)
(218) 745-4601
Entity
Organization
Contact information
Practice address
205 W JOHNSON AVE, SUITE 3, WARREN, MN 56762-1118
(218) 745-4601
Mailing address
205 W JOHNSON AVE, SUITE 3, WARREN, MN 56762-1118
(218) 745-4601
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
D12024
MN
Other
Enumeration date
09/18/2009
Last updated
09/18/2009
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