Provider Demographics
NPI:1881780864
Name:CHILDREN'S DENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:507-273-7257
Mailing Address - Street 1:903 W CENTER ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-6278
Mailing Address - Country:US
Mailing Address - Phone:507-273-7257
Mailing Address - Fax:507-529-0435
Practice Address - Street 1:903 W CENTER ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-6278
Practice Address - Country:US
Practice Address - Phone:507-273-7257
Practice Address - Fax:507-529-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH3646261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental