Provider Demographics
NPI:1396186813
Name:CENTRAL MINNESOTA PEDIATRIC DENTISTS PA
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA PEDIATRIC DENTISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-253-0272
Mailing Address - Street 1:1900 CENTRACARE CIR STE 350
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-253-0272
Mailing Address - Fax:320-251-2661
Practice Address - Street 1:507 N NOKOMIS ST STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2353
Practice Address - Country:US
Practice Address - Phone:320-253-0272
Practice Address - Fax:320-251-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND77651223P0221X
MND110731223P0221X
MND113441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty