Organization
PERIODONTAL SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYIA BUCHER (PRACTICE ADMINISTRATOR)
(507) 451-8151
Entity
Organization
Contact information
Practice address
2112 VIKING DR NW, ROCHESTER, MN 55901-3522
(507) 288-1338
Mailing address
2112 VIKING DR NW, ROCHESTER, MN 55901-3522
(507) 288-1338
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
07829
MN
Other
Enumeration date
11/07/2006
Last updated
08/22/2020
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