| Grand Avenue Dental, Llc | |
|
960 Grand Ave Saint Paul MN 55105-3014 | |
| (651) 291-9667 | |
| Not Available |
| Full Name | Grand Avenue Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 960 Grand Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Robert S Tyler (BUSINESS MANAGER) |
| Authorized Official Contact | 6512919667 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Avenue Dental, Llc 960 Grand Ave Saint Paul MN 55105-3014 Ph: (651) 291-9667 | Grand Avenue Dental, Llc 960 Grand Ave Saint Paul MN 55105-3014 Ph: (651) 291-9667 |
| NPI Number | 1154933661 |
|---|---|
| Provider Enumeration Date | 08/18/2020 |
| Last Update Date | 08/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154933661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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