Provider Demographics
NPI:1992385942
Name:PRAIRIES EDGE DENTAL LLC
Entity Type:Organization
Organization Name:PRAIRIES EDGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-739-2297
Mailing Address - Street 1:106 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2853
Mailing Address - Country:US
Mailing Address - Phone:218-739-2297
Mailing Address - Fax:218-739-4142
Practice Address - Street 1:106 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2853
Practice Address - Country:US
Practice Address - Phone:218-739-2297
Practice Address - Fax:218-739-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental