Hanover Dental | |
411 Labeaux Ave Ne Hanover MN 55341 | |
(763) 400-3005 | |
Not Available |
Full Name | Hanover Dental |
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Speciality | Clinic/center - Dental |
Location | 411 Labeaux Ave Ne, Hanover, Minnesota |
Authorized Official Name and Position | Tyler James Koivisto (DENTIST) |
Authorized Official Contact | 7632267379 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Hanover Dental 1192 Bice Ave Nw Buffalo MN 55313-4456 Ph: (763) 226-7379 | Hanover Dental 411 Labeaux Ave Ne Hanover MN 55341 Ph: (763) 400-3005 |
NPI Number | 1487147260 |
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Provider Enumeration Date | 06/07/2018 |
Last Update Date | 06/07/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487147260 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | D13236 (Minnesota) | Primary |