1881746469 NPI number — DR. MARGUERITE M CHIOVITTI PODGORSEK DDS

Table of content: DR. MARGUERITE M CHIOVITTI PODGORSEK DDS (NPI 1881746469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881746469 NPI number — DR. MARGUERITE M CHIOVITTI PODGORSEK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIOVITTI PODGORSEK
Provider First Name:
MARGUERITE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHIOVITTI
Provider Other First Name:
MARGURITE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881746469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7718 SAINT LOUIS RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55810-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-624-3725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FOND DU LAC HUMAN SERVICES DIVISION
Provider Second Line Business Practice Location Address:
927 TRETTEL LANE
Provider Business Practice Location Address City Name:
CLOQUET
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-879-1227
Provider Business Practice Location Address Fax Number:
218-878-2188
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  D9650 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 773822600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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