Edward Thomas McNiece, DDS
Individual provider Active NPI Dentist · Worthington, MN
NPI 1306984539 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306984539
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8114 (MN)
- Practice address
- 1027 Second Ave
Worthington, MN 56187 - Phone
- (507) 372-7339
- Fax
- (507) 372-7339
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8114 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Applewhite Dental Minnesota, P.C. | Dentist | Past | Accepting new patients |
| E.T. McNiece DDS, P.a. | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8114 | MN | Yes |
Addresses
Primary practice location
1027 Second Ave
Worthington, MN 56187
Mailing address
1201 Elmwood Ave
Worthington, MN 56187
Phone (507) 372-7472
Other providers in Worthington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.