Organization
OTTERTAIL DENTAL
Active
Other names
Otter Tail Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SONJA ANN JOHNSON (BUSINESS MANAGER)
(218) 739-3245
Entity
Organization
Contact information
Practice address
1409 COLLEGE WAY, FERGUS FALLS, MN 56537-1055
(218) 739-3245
(218) 739-5626
Mailing address
1409 COLLEGE WAY, FERGUS FALLS, MN 56537-1055
(218) 739-3245
(218) 739-5626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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