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825 Nicollet Mall Suite 707 Medical Arts Building Minneapolis MN 55402-2606 | |
| (612) 333-3381 | |
| (612) 334-3318 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 825 Nicollet Mall, Minneapolis, Minnesota |
| Authorized Official Name and Position | Michael K Sutley (PRESIDENT) |
| Authorized Official Contact | 6123333381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
825 Nicollet Mall Suite 707 Medical Arts Building Minneapolis MN 55402-2606 Ph: (612) 333-3381 | 825 Nicollet Mall Suite 707 Medical Arts Building Minneapolis MN 55402-2606 Ph: (612) 333-3381 |
| NPI Number | 1497890594 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497890594 | NPI | - | NPPES |
| 41426OR | Other | MN | BLUE CROSS BLUE SHIELD |
| 8080107 | Other | MN | MEDICA MEDICAL |
| 01007972 | Other | MN | PREFERRED ONE |
| 8622286 | Other | MN | MEDICA DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D9086 (Minnesota) | Primary |
Nicollet Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6101 Nicollet Ave. So., Minneapolis, MN 55419 Phone: 612-866-8550 Fax: 612-866-9453 | |
Craig J Brandenburg Dds Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5201 Bloomington Ave, Minneapolis, MN 55417 Phone: 612-721-6233 Fax: 612-721-5723 | |
West River Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4103 E Lake St, Minneapolis, MN 55406 Phone: 612-721-2424 Fax: 612-721-3054 | |
Minneapolis Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 S 5th St Ste 1475, Minneapolis, MN 55402 Phone: 612-332-1255 Fax: 612-388-3721 |