Organization
HANOVER DENTAL PLLC
Active
Other names
Hanover Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER JAMES KOIVISTO DDS (DENTIST)
(763) 226-7379
Entity
Organization
Contact information
Practice address
411 LABEAUX AVE NE, HANOVER, MN 55341
(763) 400-3005
Mailing address
1192 BICE AVE NW, BUFFALO, MN 55313-4456
(763) 226-7379
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D13236
MN
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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