1902917651 NPI number — RENVILLE COUNTY

Table of content: DR. BRIAN WILLIAM DUGONI D.D.S., M.S.D. (NPI 1700193240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902917651 NPI number — RENVILLE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENVILLE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902917651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 S 5TH ST
Provider Second Line Business Mailing Address:
SUITE 119H
Provider Business Mailing Address City Name:
OLIVIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56277-1375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-523-2570
Provider Business Mailing Address Fax Number:
320-523-3749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 S 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 119H
Provider Business Practice Location Address City Name:
OLIVIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56277-1375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-523-2570
Provider Business Practice Location Address Fax Number:
320-523-3749
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNS
Authorized Official First Name:
JILL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
320-523-3723

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 331319 , 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: 080855500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83-00091 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 114585 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2211ARE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2091221200 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G538RE . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 91562 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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