| Pediatric Dental Care | |
|
150 E 4th St Winona MN 55987-3512 | |
| (507) 452-1543 | |
| (507) 452-6874 |
| Full Name | Pediatric Dental Care |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 150 E 4th St, Winona, Minnesota |
| Authorized Official Name and Position | Christopher E Carroll (OWNER) |
| Authorized Official Contact | 5074521543 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Care 150 E 4th St Winona MN 55987-3512 Ph: (507) 452-1543 | Pediatric Dental Care 150 E 4th St Winona MN 55987-3512 Ph: (507) 452-1543 |
| NPI Number | 1275756488 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275756488 | NPI | - | NPPES |
| 4822990 | Other | MN | MN TAX ID |
| 33461700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8405 (Minnesota) | Primary |
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