Provider Demographics
NPI:1114076619
Name:DENTISTRY FOR CHILDREN AND ADOLESCENTS, LTD.
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN AND ADOLESCENTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:LOEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-288-8060
Mailing Address - Street 1:2743 SUPERIOR DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1773
Mailing Address - Country:US
Mailing Address - Phone:507-288-8060
Mailing Address - Fax:507-288-3344
Practice Address - Street 1:2743 SUPERIOR DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1773
Practice Address - Country:US
Practice Address - Phone:507-288-8060
Practice Address - Fax:507-288-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty