Provider Demographics
NPI:1356161269
Name:SOUTHERN MINNESOTA SLEEP CENTER, PLLC
Entity type:Organization
Organization Name:SOUTHERN MINNESOTA SLEEP CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-501-1577
Mailing Address - Street 1:110 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MN
Mailing Address - Zip Code:56069-1514
Mailing Address - Country:US
Mailing Address - Phone:612-501-1577
Mailing Address - Fax:
Practice Address - Street 1:146 W CLARK ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2546
Practice Address - Country:US
Practice Address - Phone:612-501-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty