Provider Demographics
NPI:1619051653
Name:FAMILY DENTAL CENTER OF CALEDONIA LLC
Entity Type:Organization
Organization Name:FAMILY DENTAL CENTER OF CALEDONIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ZARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-725-5254
Mailing Address - Street 1:BOX 72
Mailing Address - Street 2:120 W MAIN ST
Mailing Address - City:CALEDONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55921
Mailing Address - Country:US
Mailing Address - Phone:507-725-5254
Mailing Address - Fax:507-725-5406
Practice Address - Street 1:120 W MAIN
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921
Practice Address - Country:US
Practice Address - Phone:507-725-5254
Practice Address - Fax:507-725-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty