Provider Demographics
NPI:1215901830
Name:MAIN STREET DENTAL CLINIC OF ROCHESTER PLLP
Entity type:Organization
Organization Name:MAIN STREET DENTAL CLINIC OF ROCHESTER PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-583-2141
Mailing Address - Street 1:3142 WELLNER DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-8388
Mailing Address - Country:US
Mailing Address - Phone:507-536-7700
Mailing Address - Fax:507-536-7703
Practice Address - Street 1:3142 WELLNER DR NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-8388
Practice Address - Country:US
Practice Address - Phone:507-536-7700
Practice Address - Fax:507-536-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61599991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty