Provider Demographics
NPI:1063530194
Name:MEDICAL ARTS DENTAL
Entity type:Organization
Organization Name:MEDICAL ARTS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-250-9270
Mailing Address - Street 1:165 19TH ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2153
Mailing Address - Country:US
Mailing Address - Phone:320-253-9270
Mailing Address - Fax:320-255-5413
Practice Address - Street 1:165 19TH ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2153
Practice Address - Country:US
Practice Address - Phone:320-253-9270
Practice Address - Fax:320-255-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty