| Health Source Dental Clinic | |
|
1425 State St Cambridge MN 55008-5033 | |
| (763) 689-7306 | |
| Not Available |
| Full Name | Health Source Dental Clinic |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 1425 State St, Cambridge, Minnesota |
| Authorized Official Name and Position | Rod L. Kornrumpf (ADULT MENTAL HEALTH ADMINISTRATOR) |
| Authorized Official Contact | 6514315003 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Source Dental Clinic Po Box 64979 Saint Paul MN 55164-0979 Ph: () - | Health Source Dental Clinic 1425 State St Cambridge MN 55008-5033 Ph: (763) 689-7306 |
| NPI Number | 1508962994 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 02/27/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508962994 | NPI | - | NPPES |
| 366053200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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