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3001 Harbor Lane Suite 100 Plymouth MN 55447 | |
| (763) 553-0451 | |
| (763) 559-3425 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3001 Harbor Lane, Plymouth, Minnesota |
| Authorized Official Name and Position | Kathleen G Swanson (DDS OWNER) |
| Authorized Official Contact | 76355530451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3001 Harbor Lane Suite 100 Plymouth MN 55447 Ph: (763) 553-0451 | 3001 Harbor Lane Suite 100 Plymouth MN 55447 Ph: (763) 553-0451 |
| NPI Number | 1265595276 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265595276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 9384 (Minnesota) | Secondary |
| 122300000X | Dentist | D11435 (Minnesota) | Primary |
| 122300000X | Dentist | 9385 (Minnesota) | Secondary |
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