| Houston Dental Clinic | |
|
109 E Maple St Houston MN 55943-8449 | |
| (507) 896-2202 | |
| Not Available |
| Full Name | Houston Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 109 E Maple St, Houston, Minnesota |
| Authorized Official Name and Position | John W Evenson (OWNER) |
| Authorized Official Contact | 5078962202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Houston Dental Clinic 109 E Maple St Houston MN 55943-8449 Ph: (507) 896-2202 | Houston Dental Clinic 109 E Maple St Houston MN 55943-8449 Ph: (507) 896-2202 |
| NPI Number | 1275763674 |
|---|---|
| Provider Enumeration Date | 07/20/2009 |
| Last Update Date | 07/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275763674 | NPI | - | NPPES |
| 459846600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D11269 (Minnesota) | Primary |
Houston Dental Clinic, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 E Maple St, Houston, MN 55943 Phone: 507-896-2202 |