Provider Demographics
NPI:1861546855
Name:SOUTHWEST PROFESSIONAL INC
Entity type:Organization
Organization Name:SOUTHWEST PROFESSIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:320-235-7742
Mailing Address - Street 1:509 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4118
Mailing Address - Country:US
Mailing Address - Phone:320-235-7742
Mailing Address - Fax:320-235-4045
Practice Address - Street 1:509 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4118
Practice Address - Country:US
Practice Address - Phone:320-235-7742
Practice Address - Fax:320-235-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty