Jack Michael Fiedler, D.D.S.
Individual provider Active NPI General Practice Dentistry · Hector, MN
NPI 1720140437 · NPPES record last updated Aug 30, 2013
Key facts
- NPI
- 1720140437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D12373 (MN)
- Practice address
- 149 Main Street S
Box 547
Hector, MN 55342 - Phone
- (320) 848-2611
- NPI assigned
- Dec 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| D12373 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westfield Dental Sleep Medicine PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D12373 | MN | Yes |
Addresses
Primary practice location
149 Main Street S
Box 547
Hector, MN 55342
Mailing address
149 Main Street S
Box 547
Hector, MN 55342
Phone (320) 848-2611
Other providers in Hector, MN
- City of Hector
- Esthetic Family Dentistry PC
- Healthpartners RC
- Paige Hofstad
- Home Care on Birch, LLC
- Jack M. Fiedler, D.D.S.,P.a.
- Daniel H Menser
All providers in Hector, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2013. 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.