Provider Demographics
NPI:1568757359
Name:HENDRICKS DENTAL OFFICE
Entity Type:Organization
Organization Name:HENDRICKS DENTAL OFFICE
Other - Org Name:ROLLAND C. DIGRE, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:DIGRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-275-3152
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136-9519
Mailing Address - Country:US
Mailing Address - Phone:507-275-3152
Mailing Address - Fax:507-275-3153
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDRICKS
Practice Address - State:MN
Practice Address - Zip Code:56136-9519
Practice Address - Country:US
Practice Address - Phone:507-275-3152
Practice Address - Fax:507-275-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty