Provider Demographics
NPI:1588041123
Name:CIRCLE DRIVE DENTAL PLLC
Entity Type:Organization
Organization Name:CIRCLE DRIVE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENCILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-289-2055
Mailing Address - Street 1:2633 SUPERIOR DR NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8522
Mailing Address - Country:US
Mailing Address - Phone:507-289-2055
Mailing Address - Fax:507-424-0159
Practice Address - Street 1:2633 SUPERIOR DR NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8522
Practice Address - Country:US
Practice Address - Phone:507-289-2055
Practice Address - Fax:507-424-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty