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56 Outer Dr Silver Bay MN 55614-1133 | |
(218) 353-8700 | |
(612) 548-5964 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 56 Outer Dr, Silver Bay, Minnesota |
Authorized Official Name and Position | Simone Renee Hogan (MDVA CHIEF OPERATIONS DIRECTOR) |
Authorized Official Contact | 6125054110 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5101 Minnehaha Ave. S Minneapolis MN 55417-1647 Ph: () - | 56 Outer Dr Silver Bay MN 55614-1133 Ph: (218) 353-8700 |
NPI Number | 1083310403 |
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Provider Enumeration Date | 02/07/2023 |
Last Update Date | 12/03/2024 |
Identifier | Type | State | Issuer |
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1083310403 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |