HANOVER DENTAL PLLC (NPI# 1487147260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487147260 |
| Entity Type | Organization |
| Organization Name | HANOVER DENTAL PLLC |
| Other Organization Name | HANOVER DENTAL |
| Practice Address |
411 Labeaux Ave Ne Hanover MN 55341 |
| Mailing Address |
1192 Bice Ave Nw Buffalo MN 55313-4456 |
| Practice Telephone | 7634003005 |
| Mailing Telephone | 7632267379 |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |
| Authorized Official Name | DR. TYLER JAMES KOIVISTO (DENTIST) |
| Authorized Official Telephone | 7632267379 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
D13236 | MN | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Hanover Dental | Doing Business As Name - Organization |
| Street Address |
411 LABEAUX AVE NE |
| City | HANOVER |
| State | MN |
| Zip Code | 55341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861546459 | George Henry Kramer | Physical Medicine & Rehabilitation | 10562 France Ave S, Bloomington, MN 55341 | 2007-01-22 |
| 1659570661 | Cummings Mobility Conversions & Supply Inc. | Durable Medical Equipment & Medical Supplies | 11238 River Rd Ne, Hanover, MN 55341-4022 | 2007-07-11 |
| 1134729486 | Anna R Spiczka | Student in an Organized Health Care Education/Training Program | 10689 108th Ave N, Hanover, MN 55341-4124 | 2020-10-27 |
| 1447478482 | Annette Ruth Shoberg | Speech-Language Pathologist | 10671 106th Ave N, Hanover, MN 55341-4400 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801642 | Allison Zilonis | Specialist/Technologist | 1923 Oak Hills Dr, Hanover, PA 17331-8522 | 2020-11-08 |
| 1386245371 | Cynthia Tessie | Family Medicine | 1398 Hawthorn Dr, Hanover, MD 21076-2197 | 2020-11-05 |
| 1669072641 | Pinnacle Health Medical Services | Nurse Practitioner | 250 Fame Ave Ste 201, Hanover, PA 17331-1587 | 2020-10-28 |
| 1063012581 | Tara Ricci | Registered Nurse | 30 Jefferson Rd, Hanover, MA 02339-1832 | 2020-10-26 |
| 1942809199 | Kristina Fleck | Physical Therapist | 1000 Carlisle St Ste 1175, Hanover, PA 17331-1191 | 2020-10-20 |
| 1457950636 | Yuriko Fujioka | Specialist/Technologist | Hb 6083 Dartmouth College Alumni Gym, Hanover, NH 03755 | 2020-10-20 |
| 1891393765 | Winsome Boykin | Nurse Practitioner | 7231 Parkway Dr, Hanover, MD 21076-1788 | 2020-10-13 |
| 1134736515 | Kimberly Taylor | Technician | 337 Rosemont Road, Hanover, WV 24839 | 2020-09-29 |
| 1285241687 | Brandi Nichole Vanover | Technician | 2714 Interstate Highway, Hanover, WV 24839 | 2020-09-29 |
| 1245844240 | Samantha Elizabeth Colaw | Occupational Therapist | 148 Old Schoolhouse Ln, Hanover, MA 02339-1356 | 2020-09-07 |
| Find all providers in HANOVER | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053871418 | Park Dentistry, LLC | Clinic/Center | 207 Dart Dr, Hanover, PA 17331-1322 | 2019-03-21 |
| 1205297546 | Providence Dental Specialists | Clinic/Center | 1731 Theale Way, Hanover, MD 21076-1899 | 2016-03-15 |
| 1851846315 | Tarik Jbarah Dmd LLC | Clinic/Center | 104 Carlisle St, Suite 2, Hanover, PA 17331-2406 | 2016-08-24 |
| 1790152205 | Tarik Jbarah Dmd LLC | Clinic/Center | 250 Fame Ave, Suite #206, Hanover, PA 17331-1587 | 2015-09-01 |
| 1477920304 | Tarik Jbarah Dmd LLC | Clinic/Center | 245 Baltimore St, Suite #2, Hanover, PA 17331-3260 | 2015-08-26 |
| 1770966806 | Tarik Jbarah | Clinic/Center | 138 Broadway, Hanover, PA 17331-2500 | 2015-07-07 |
| 1083093322 | David Bonebreak Dds Ms LLC | Clinic/Center | 7556 Teague Rd, Suite 106, Hanover, MD 21076-1213 | 2015-05-20 |
| 1770753279 | Joan Werleman Dds PC | Clinic/Center | 195 Stock St, Suite 310, Hanover, PA 17331-2266 | 2008-03-11 |
| 1598949539 | Ba & We Trummer Dds LLC | Clinic/Center | 454 Carlisle St, Hanover, PA 17331-2107 | 2007-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033710025 | Theresa M. Snell | Clinic/Center | 580 5th Ave Nw Ste 100, New Brighton, MN 55112-2836 | 2020-11-05 |
| 1376143248 | James M. Williams, D.d.s., P.a. | Clinic/Center | 620 Union St S, Mora, MN 55051-1818 | 2020-10-29 |
| 1235746058 | Asp Dental, PC | Clinic/Center | 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345-4103 | 2020-09-25 |
| 1952918781 | Asp Dental, PC | Clinic/Center | 9800 Shelard Pkwy Ste 130, Plymouth, MN 55441-6451 | 2020-09-25 |
| 1518574532 | Stillwater Family Dental | Clinic/Center | 13481 60th St N Ste 100, Oak Park Heights, MN 55082-1089 | 2020-09-24 |
| 1093321531 | Barnett Dental Inc | Clinic/Center | 7962 Sunwood Dr Nw Ste 200, Ramsey, MN 55303-5172 | 2020-09-21 |
| 1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
| 1770195158 | Mark T. Sherman Dds Pa | Clinic/Center | 31011 Rasmussen Rd, Pequot Lakes, MN 56472-1227 | 2020-08-18 |
| 1689286015 | Lifelong Dental Care | Clinic/Center | 1525 Livingston Ave Ste B, West St Paul, MN 55118-3430 | 2020-08-18 |
| 1528678497 | Custom Smiles Dentistry, Pllc | Clinic/Center | 2258 Bunker Lake Blvd Nw, Andover, MN 55304-3900 | 2020-08-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.