Crater, Diane Vavrik

Crater, Diane Vavrik is an individual health care provider with primary practice located at 8063 Hadley Ave S , Cottage Grove MN 55016-2652. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Crater, Diane Vavrik can be contacted via phone (651) 459-4894.

Contact Information

Primary practice address
8063 Hadley Ave S Cottage Grove MN 55016-2652
Phone: (651) 459-4894
Fax: (651) 458-4940
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 9628 Minnesota

Profile Details

NPI number 1154375327
LBN Legal business name Crater, Diane Vavrik
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date May 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154375327 NPPES
Other 1151079 MN TAX ID
Other 2167963000 MN TAX ID

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