Organization
4TH AVENUE DENTAL, PA, DBA OAK PARK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA ASCHEMAN (SUPERVISOR/OWNER)
(320) 629-2282
Entity
Organization
Contact information
Practice address
505 JOHNSON AVE SE, PINE CITY, MN 55063-2108
(320) 629-2282
(320) 629-3357
Mailing address
505 JOHNSON AVE SE, PINE CITY, MN 55063-2108
(320) 629-2282
(320) 629-3357
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11935
MN
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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