Organization
AVERA MARSHALL
Active
Parent organization
AVERA MARSHALL
Other names
Avera Medical Group Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVERA MARSHALL
Authorized official
DEBBIE STREIER (CEO)
(507) 537-9160
Entity
Organization
Contact information
Practice address
197 N TYLER ST, TYLER, MN 56178-1160
(507) 247-5591
Mailing address
197 N TYLER ST, TYLER, MN 56178-1160
(507) 247-5591
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NOT ASSIGNED YET
NOT ASSIGNED YET
—
Enumeration date
05/18/2016
Last updated
12/02/2022
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