Provider Demographics
NPI:1275797763
Name:BYRON ROWELL PA
Entity Type:Organization
Organization Name:BYRON ROWELL PA
Other - Org Name:ROWELL FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-326-1266
Mailing Address - Street 1:510 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2627
Mailing Address - Country:US
Mailing Address - Phone:218-326-1266
Mailing Address - Fax:218-326-9502
Practice Address - Street 1:510 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2627
Practice Address - Country:US
Practice Address - Phone:218-326-1266
Practice Address - Fax:218-326-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8282261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN632317100OtherMN CARE