| East Side Family Dental Clinic | |
|
895 E. 7th St St Paul MN 55106-3852 | |
| (651) 772-9757 | |
| (651) 772-9959 |
| Full Name | East Side Family Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 895 E. 7th St, St Paul, Minnesota |
| Authorized Official Name and Position | Reuben Moore (CEO) |
| Authorized Official Contact | 6516027500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Side Family Dental Clinic 153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 602-7500 | East Side Family Dental Clinic 895 E. 7th St St Paul MN 55106-3852 Ph: (651) 772-9757 |
| NPI Number | 1912058058 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912058058 | NPI | - | NPPES |
| 955353300 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 302133 (Minnesota) | Primary |
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