Provider Demographics
NPI:1215027479
Name:FIEDLER, WILLIAM RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321
Mailing Address - Country:US
Mailing Address - Phone:320-286-2712
Mailing Address - Fax:320-286-6400
Practice Address - Street 1:115 OLSEN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321
Practice Address - Country:US
Practice Address - Phone:320-286-2712
Practice Address - Fax:320-286-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist