Provider Demographics
NPI:1578857587
Name:MELROSE DENTAL OFFICE LLC
Entity type:Organization
Organization Name:MELROSE DENTAL OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-256-4267
Mailing Address - Street 1:203 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-4524
Mailing Address - Country:US
Mailing Address - Phone:320-256-4267
Mailing Address - Fax:320-256-4167
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-4524
Practice Address - Country:US
Practice Address - Phone:320-256-4267
Practice Address - Fax:320-256-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty