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4554 Minnehaha Ave Minneapolis MN 55406 | |
| (612) 721-3012 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4554 Minnehaha Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Jenna Lynn Swenson (OWNER) |
| Authorized Official Contact | 3207612259 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4554 Minnehaha Ave Minneapolis MN 55406 Ph: (612) 721-3012 | 4554 Minnehaha Ave Minneapolis MN 55406 Ph: (612) 721-3012 |
| NPI Number | 1104977222 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 12/31/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104977222 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 10142 (Minnesota) | Primary |
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