Provider Demographics
NPI:1538264874
Name:OWATONNA DENTAL CARE
Entity type:Organization
Organization Name:OWATONNA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TRILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-451-2226
Mailing Address - Street 1:1414 S OAK AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3900
Mailing Address - Country:US
Mailing Address - Phone:507-451-2226
Mailing Address - Fax:507-455-9224
Practice Address - Street 1:1414 S OAK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3900
Practice Address - Country:US
Practice Address - Phone:507-451-2226
Practice Address - Fax:507-455-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty