Provider Demographics
NPI:1508280009
Name:FIEDLER DENTISTRY, PA
Entity Type:Organization
Organization Name:FIEDLER DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-286-2712
Mailing Address - Street 1:115 OLSEN BLVD NE STE 200
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4797
Mailing Address - Country:US
Mailing Address - Phone:320-286-2712
Mailing Address - Fax:
Practice Address - Street 1:115 OLSEN BLVD NE STE 200
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4797
Practice Address - Country:US
Practice Address - Phone:320-286-2712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty