Organization
GREENHAVEN FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL OSBORN (INSURANCE COORDINATOR)
(218) 454-0523
Entity
Organization
Contact information
Practice address
13495 ELDER DR, SUITE 100, BAXTER, MN 56425-8763
(218) 454-0523
(218) 454-0524
Mailing address
13495 ELDER DR, SUITE 100, BAXTER, MN 56425-8763
(218) 454-0523
(218) 454-0524
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10518
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
674722100
—
MN
Enumeration date
08/07/2008
Last updated
08/07/2008
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