Provider Demographics
NPI:1750465753
Name:HANSON AND FONKERT DENTAL CLINIC PA
Entity Type:Organization
Organization Name:HANSON AND FONKERT DENTAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TOMI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PIRROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-2780
Mailing Address - Street 1:1101 SOUTH FIRST STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3595
Mailing Address - Country:US
Mailing Address - Phone:320-235-2780
Mailing Address - Fax:320-235-8838
Practice Address - Street 1:1101 SOUTH FIRST STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3595
Practice Address - Country:US
Practice Address - Phone:320-235-2780
Practice Address - Fax:320-235-8838
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
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty