Provider Demographics
NPI:1659650893
Name:ELGIN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ELGIN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-876-0127
Mailing Address - Street 1:124 2ND AVE SE
Mailing Address - Street 2:P.O. BOX #10
Mailing Address - City:ELGIN
Mailing Address - State:MN
Mailing Address - Zip Code:55932-9732
Mailing Address - Country:US
Mailing Address - Phone:507-876-0127
Mailing Address - Fax:
Practice Address - Street 1:124 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:MN
Practice Address - Zip Code:55932-9732
Practice Address - Country:US
Practice Address - Phone:507-876-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty