Provider Demographics
NPI:1649590829
Name:DR. DENNIS L. NIERENGARTEN, D.D.S., P.A.
Entity Type:Organization
Organization Name:DR. DENNIS L. NIERENGARTEN, D.D.S., P.A.
Other - Org Name:EXCELLENCE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIERENGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:320-255-1020
Mailing Address - Street 1:1511 NORTHWAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1262
Mailing Address - Country:US
Mailing Address - Phone:320-255-1020
Mailing Address - Fax:320-255-1020
Practice Address - Street 1:1511 NORTHWAY DR STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1262
Practice Address - Country:US
Practice Address - Phone:320-255-1020
Practice Address - Fax:320-255-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9004302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1487691887OtherDR. PERSONAL NPI TYPE 1
MN1023043205OtherASSOCIATE DR PERSONAL NPI