Provider Demographics
NPI:1710215793
Name:SHETEK DENTAL CARE PA
Entity Type:Organization
Organization Name:SHETEK DENTAL CARE PA
Other - Org Name:SHETEK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NARLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HULSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CDA, RDA
Authorized Official - Phone:507-836-1000
Mailing Address - Street 1:2711 BROADWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1313
Mailing Address - Country:US
Mailing Address - Phone:507-836-1000
Mailing Address - Fax:507-836-1008
Practice Address - Street 1:2711 BROADWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1313
Practice Address - Country:US
Practice Address - Phone:507-836-1000
Practice Address - Fax:507-836-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty