Provider Demographics
NPI:1225258247
Name:DENTAL HEALTH SERVICES MINNEWASKA PLLC
Entity Type:Organization
Organization Name:DENTAL HEALTH SERVICES MINNEWASKA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER W DR JEREMY MYROM
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RINGDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-634-3556
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:1616 N FRANKLIN STR
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334
Mailing Address - Country:US
Mailing Address - Phone:320-634-3556
Mailing Address - Fax:320-634-3567
Practice Address - Street 1:1616 N FRANKLIN STR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334
Practice Address - Country:US
Practice Address - Phone:320-634-3556
Practice Address - Fax:320-634-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty