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421 W 4th St Red Wing MN 55066-2555 | |
| (651) 388-6709 | |
| (651) 388-3187 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 421 W 4th St, Red Wing, Minnesota |
| Authorized Official Name and Position | Dennis Peter Vaillant (MANAGING PARTNER) |
| Authorized Official Contact | 6513886709 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
421 W 4th St Red Wing MN 55066-2555 Ph: (651) 388-6709 | 421 W 4th St Red Wing MN 55066-2555 Ph: (651) 388-6709 |
| NPI Number | 1326243114 |
|---|---|
| Provider Enumeration Date | 06/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326243114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 7024 (Minnesota) | Primary |
| 1223G0001X | Dentist - General Practice | 11524 (Minnesota) | Secondary |
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