Provider Demographics
NPI:1053602888
Name:APPLE VALLEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:APPLE VALLEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PROESCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-432-7145
Mailing Address - Street 1:7493 147TH ST W
Mailing Address - Street 2:SUITE #100
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4505
Mailing Address - Country:US
Mailing Address - Phone:952-432-7145
Mailing Address - Fax:952-432-6886
Practice Address - Street 1:7493 147TH ST W
Practice Address - Street 2:SUITE #100
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4505
Practice Address - Country:US
Practice Address - Phone:952-432-7145
Practice Address - Fax:952-432-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND79261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty