Provider Demographics
NPI:1609105816
Name:BREMSETH FAMILY DENTAL PA
Entity Type:Organization
Organization Name:BREMSETH FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BREMSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-388-3535
Mailing Address - Street 1:621 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2413
Mailing Address - Country:US
Mailing Address - Phone:651-388-3535
Mailing Address - Fax:651-388-5152
Practice Address - Street 1:621 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2413
Practice Address - Country:US
Practice Address - Phone:651-388-3535
Practice Address - Fax:651-388-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10623261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental