Provider Demographics
NPI:1871656975
Name:POSSELT, JOHN MONRATH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MONRATH
Last Name:POSSELT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 WHITE OAK DR
Mailing Address - Street 2:#275
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318
Mailing Address - Country:US
Mailing Address - Phone:952-448-2868
Mailing Address - Fax:952-448-7447
Practice Address - Street 1:1580 WHITE OAK DR
Practice Address - Street 2:#275
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-448-2868
Practice Address - Fax:952-448-7447
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist