| Dental Clinic | |
|
606 24th Ave S Suite 200 Minneapolis MN 55454-1455 | |
| (812) 659-8689 | |
| (612) 659-8690 |
| Full Name | Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 606 24th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Mary Johnson (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 6128840802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Clinic 606 24th Ave S Suite 200 Minneapolis MN 55454-1455 Ph: (612) 659-8689 | Dental Clinic 606 24th Ave S Suite 200 Minneapolis MN 55454-1455 Ph: (812) 659-8689 |
| NPI Number | 1952546061 |
|---|---|
| Provider Enumeration Date | 12/04/2008 |
| Last Update Date | 06/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952546061 | NPI | - | NPPES |
| 701372800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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