| Minneapolis Oral & Maxillofacial Surgery | |
|
825 Nicollet Mall Suite 707 Medical Arts Building Minneapolis MN 55402-2606 | |
| (612) 333-3381 | |
| (612) 334-3318 |
| Full Name | Minneapolis Oral & Maxillofacial Surgery |
|---|---|
| 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 |
|---|---|
| Minneapolis Oral & Maxillofacial Surgery 825 Nicollet Mall Suite 707 Medical Arts Building Minneapolis MN 55402-2606 Ph: (612) 333-3381 | Minneapolis Oral & Maxillofacial Surgery 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 |
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