Provider Demographics
NPI:1487691887
Name:NIERENGARTEN, DENNIS LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:NIERENGARTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NORTHWAY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1261
Mailing Address - Country:US
Mailing Address - Phone:320-255-1020
Mailing Address - Fax:320-255-1732
Practice Address - Street 1:1511 NORTHWAY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1261
Practice Address - Country:US
Practice Address - Phone:320-255-1020
Practice Address - Fax:320-255-1732
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice