| Minneapolis-st. Paul Periodontics | |
|
1109 East Moore Lake Drive Fridley MN 55432 | |
| (651) 439-2600 | |
| (651) 439-2211 |
| Full Name | Minneapolis-st. Paul Periodontics |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1109 East Moore Lake Drive, Fridley, Minnesota |
| Authorized Official Name and Position | Doug S Wolff (OWNER) |
| Authorized Official Contact | 6514392600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Minneapolis-st. Paul Periodontics 1109 East Moore Lake Drive Fridley MN 55432 Ph: (651) 439-2600 | Minneapolis-st. Paul Periodontics 1109 East Moore Lake Drive Fridley MN 55432 Ph: (651) 439-2600 |
| NPI Number | 1013216811 |
|---|---|
| Provider Enumeration Date | 03/18/2011 |
| Last Update Date | 03/18/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013216811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | D11710 (Minnesota) | Primary |
The Dental Specialists Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1109 Moore Lake Dr E, Fridley, MN 55432 Phone: 763-571-9990 Fax: 763-572-2226 | |
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