Provider Demographics
NPI:1881746469
Name:CHIOVITTI PODGORSEK, MARGUERITE M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:M
Last Name:CHIOVITTI PODGORSEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:MARGURITE
Other - Middle Name:M
Other - Last Name:CHIOVITTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7718 SAINT LOUIS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55810-1101
Mailing Address - Country:US
Mailing Address - Phone:218-624-3725
Mailing Address - Fax:
Practice Address - Street 1:FOND DU LAC HUMAN SERVICES DIVISION
Practice Address - Street 2:927 TRETTEL LANE
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720
Practice Address - Country:US
Practice Address - Phone:218-879-1227
Practice Address - Fax:218-878-2188
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND96501223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN773822600Medicaid
MNBC0849084OtherDEA