Provider Demographics
NPI:1215606355
Name:WINDOM FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:WINDOM FAMILY DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KARELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-298-1815
Mailing Address - Street 1:820 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1761
Mailing Address - Country:US
Mailing Address - Phone:507-831-3717
Mailing Address - Fax:
Practice Address - Street 1:820 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1761
Practice Address - Country:US
Practice Address - Phone:507-831-3717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty