Organization
THE DENTISTS HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK LAVERN OHLSEN DOCTOR (DENTISTS)
(507) 334-7471
Entity
Organization
Contact information
Practice address
505 4TH ST NW, FARIBAULT, MN 55021-5032
(507) 334-7471
Mailing address
505 4TH ST NW, FARIBAULT, MN 55021-5032
(507) 334-7471
(507) 334-9736
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10296
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273522900
MEDICAL ASSISTANCE
MN
Enumeration date
06/30/2008
Last updated
06/30/2008
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