Provider Demographics
NPI:1053427237
Name:SANDSTONE DENTAL OFFICE
Entity type:Organization
Organization Name:SANDSTONE DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-245-2208
Mailing Address - Street 1:501 N COMMERCIAL AVE
Mailing Address - Street 2:PO BOX 589
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-0589
Mailing Address - Country:US
Mailing Address - Phone:320-245-2208
Mailing Address - Fax:320-245-2208
Practice Address - Street 1:501 N COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-0589
Practice Address - Country:US
Practice Address - Phone:320-245-2208
Practice Address - Fax:320-245-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty