4th Avenue Dental, Pa, DBA Oak Park Dental

NPI #1609298355 in Pine City, Minnesota

Provider Information

NPI Number: 1609298355
Entity Type: Organization
Organization Name: 4th Avenue Dental, Pa, DBA Oak Park Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 15, 2014
Last Updated: Jan 15, 2014

Practice Location

Address: 505 JOHNSON AVE SE
City: Pine City
State: Minnesota
ZIP Code: 55063-2108
Phone: (320) 629-2282

Authorized Official

Name: ALICIA ASCHEMAN
Title: SUPERVISOR/OWNER
Phone: (320) 629-2282

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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