Provider Demographics
NPI:1700058690
Name:ORONO DENTAL CARE PC
Entity type:Organization
Organization Name:ORONO DENTAL CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-449-9494
Mailing Address - Street 1:2765 KELLEY PARKWAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356
Mailing Address - Country:US
Mailing Address - Phone:952-449-9494
Mailing Address - Fax:952-449-9499
Practice Address - Street 1:2765 KELLEY PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55356
Practice Address - Country:US
Practice Address - Phone:952-449-9494
Practice Address - Fax:952-449-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty