| Dental South Pa | |
|
800 Marie Avenue South St Paul MN 55075 | |
| (651) 451-1277 | |
| (651) 455-8488 |
| Full Name | Dental South Pa |
|---|---|
| Speciality | Dentist |
| Location | 800 Marie Avenue, South St Paul, Minnesota |
| Authorized Official Name and Position | Michael J. Prueher (OWNER/DENTIST) |
| Authorized Official Contact | 6514511277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental South Pa 800 Marie Avenue South St Paul MN 55075 Ph: (651) 451-1277 | Dental South Pa 800 Marie Avenue South St Paul MN 55075 Ph: (651) 451-1277 |
| NPI Number | 1558431890 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 12/02/2019 |
| Medicare PECOS PAC ID | 1951633742 |
|---|---|
| Medicare Enrollment ID | O20191206000896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558431890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 9619 (Minnesota) | Primary |
| Provider Name | Michael J Prueher |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528272887 PECOS PAC ID: 9032441829 Enrollment ID: I20191030000456 |
St. Paul Oral Surgery, P.a. Dental Clinic Medicare: Medicare Enrolled Practice Location: 710 19th Ave N, Suite 300, South St Paul, MN 55075 Phone: 651-451-1873 Fax: 651-451-8010 |