Provider Demographics
NPI:1437138583
Name:HINCKLEY DENTAL CENTER P. A.
Entity Type:Organization
Organization Name:HINCKLEY DENTAL CENTER P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GROTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-384-6118
Mailing Address - Street 1:302 FIRE MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-8350
Mailing Address - Country:US
Mailing Address - Phone:320-384-6118
Mailing Address - Fax:320-384-6832
Practice Address - Street 1:302 FIRE MONUMENT RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037-8350
Practice Address - Country:US
Practice Address - Phone:320-384-6118
Practice Address - Fax:320-384-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND89391223G0001X
MND108541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty