Provider Demographics
NPI:1326161845
Name:TURNER, DOMINIC C (PT)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:C
Last Name:TURNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1977
Mailing Address - Country:US
Mailing Address - Phone:320-251-2600
Mailing Address - Fax:320-251-4763
Practice Address - Street 1:100 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1977
Practice Address - Country:US
Practice Address - Phone:320-251-2600
Practice Address - Fax:320-251-4763
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6255171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGMedicaid
MN1326161845Medicaid
MN650001937Medicare PIN
MNPENDINGMedicaid