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4205 Lancaster Ln N Ste 101 Plymouth MN 55441-1702 | |
| (763) 559-2976 | |
| (763) 559-4852 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4205 Lancaster Ln N Ste 101, Plymouth, Minnesota |
| Authorized Official Name and Position | Kersten Hoffman (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 9524750225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
109 Bushaway Rd Ste 300 Wayzata MN 55391-2079 Ph: (952) 475-0225 | 4205 Lancaster Ln N Ste 101 Plymouth MN 55441-1702 Ph: (763) 559-2976 |
| NPI Number | 1194215616 |
|---|---|
| Provider Enumeration Date | 05/10/2018 |
| Last Update Date | 05/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194215616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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