| Enterprise Dental, Inc. | |
|
2418 Enterprise Dr Unit B Mendota Heights MN 55120-1361 | |
| (651) 452-2116 | |
| (651) 452-2695 |
| Full Name | Enterprise Dental, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2418 Enterprise Dr Unit B, Mendota Heights, Minnesota |
| Authorized Official Name and Position | Wendy Lee Koury (PRESIDENT) |
| Authorized Official Contact | 6514522116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enterprise Dental, Inc. 2418 Enterprise Dr Unit B Mendota Heights MN 55120-1361 Ph: (651) 452-2116 | Enterprise Dental, Inc. 2418 Enterprise Dr Unit B Mendota Heights MN 55120-1361 Ph: (651) 452-2116 |
| NPI Number | 1447422175 |
|---|---|
| Provider Enumeration Date | 04/02/2008 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447422175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D10401 (Minnesota) | Primary |
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