| Bucca Dental Llc | |
|
1508 E Lake St Minneapolis MN 55407-1720 | |
| (612) 724-1717 | |
| (612) 724-3114 |
| Full Name | Bucca Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1508 E Lake St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Edgar Fernando Mantilla (CEO) |
| Authorized Official Contact | 6127241717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bucca Dental Llc 1508 E Lake St Minneapolis MN 55407-1720 Ph: (612) 724-1717 | Bucca Dental Llc 1508 E Lake St Minneapolis MN 55407-1720 Ph: (612) 724-1717 |
| NPI Number | 1750774428 |
|---|---|
| Provider Enumeration Date | 03/05/2015 |
| Last Update Date | 03/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750774428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D11889 (Minnesota) | Primary |
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