Provider Demographics
NPI:1275189607
Name:BLUESTEM DENTAL PLLC
Entity Type:Organization
Organization Name:BLUESTEM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HILLEREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-842-4191
Mailing Address - Street 1:33494 290TH AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-3102
Mailing Address - Country:US
Mailing Address - Phone:320-444-4033
Mailing Address - Fax:320-843-4208
Practice Address - Street 1:210 13TH ST S
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1821
Practice Address - Country:US
Practice Address - Phone:320-842-4191
Practice Address - Fax:320-843-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty