Provider Demographics
NPI:1881639201
Name:PLOTZ, GARY DANE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DANE
Last Name:PLOTZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:320-266-0838
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN122291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice