Provider Demographics
NPI:1326618943
Name:MCGREGOR AREA DENTAL PLLC
Entity Type:Organization
Organization Name:MCGREGOR AREA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-768-4111
Mailing Address - Street 1:13154 200TH ST
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-3091
Mailing Address - Country:US
Mailing Address - Phone:320-333-6134
Mailing Address - Fax:
Practice Address - Street 1:255 W HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760-5003
Practice Address - Country:US
Practice Address - Phone:320-333-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty