AVERA MARSHALL NPI 1962859058

NPI Information

NPI: 1962859058
Provider Name: AVERA MARSHALL
Classification: Dentist - 122300000X
Entity Type: Organization
Doing Business As: AVERA MEDICAL GROUP DENTAL CARE
CLIA Number: 24D0405330
Address: 197 N TYLER ST
TYLER, MN
ZIP 56178
Phone: (507) 247-5591

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NPI Details

AVERA MARSHALL is a dentist in Tyler, MN. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. AVERA MARSHALL NPI is 1962859058. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Avera Medical Group Dental Care.

The provider's business location address is:

197 N TYLER ST
TYLER, MN
ZIP 56178-160
Phone: (507) 247-5591

The provider's authorized official is Debbie Streier .
The authorized official title is Ceo and has the following contact phone number (507) 537-9160.

The CLIA number assigned to this NPI record is 24D0405330 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/18/2016 and was last updated on 12/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist			MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	NOT ASSIGNED YET	OTHER		NOT ASSIGNED YET

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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