Provider Demographics
NPI:1154650380
Name:BREMSETH FAMILY DENTAL PA
Entity Type:Organization
Organization Name:BREMSETH FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BREMSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-732-7444
Mailing Address - Street 1:404 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1601
Mailing Address - Country:US
Mailing Address - Phone:507-732-7444
Mailing Address - Fax:507-732-7447
Practice Address - Street 1:404 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-1601
Practice Address - Country:US
Practice Address - Phone:507-732-7444
Practice Address - Fax:507-732-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental