| Distinctive Dental | |
|
417 Lincoln Ave Nw Faribault MN 55021-4952 | |
| (507) 332-8888 | |
| Not Available |
| Full Name | Distinctive Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 417 Lincoln Ave Nw, Faribault, Minnesota |
| Authorized Official Name and Position | Charles N Miller (PRESIDENT) |
| Authorized Official Contact | 5073328888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Distinctive Dental 417 Lincoln Ave Nw Faribault MN 55021-4952 Ph: (507) 332-8888 | Distinctive Dental 417 Lincoln Ave Nw Faribault MN 55021-4952 Ph: (507) 332-8888 |
| NPI Number | 1538469598 |
|---|---|
| Provider Enumeration Date | 10/25/2010 |
| Last Update Date | 08/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538469598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D10738 (Minnesota) | Primary |
| 1223G0001X | Dentist - General Practice | D7255 (Minnesota) | Secondary |
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Dr. Warren Johnson, Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 422 Heritage Place, Faribault, MN 55021 Phone: 507-334-5602 Fax: 507-334-3488 |