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510 Marquette Ave Suite 100 Minneapolis MN 55402-1110 | |
| (612) 338-5557 | |
| (612) 373-0602 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 510 Marquette Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Lori Jacobs (OFFICE MANAGER) |
| Authorized Official Contact | 6123385557 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 Marquette Ave Suite 100 Minneapolis MN 55402-1110 Ph: (612) 338-5557 | 510 Marquette Ave Suite 100 Minneapolis MN 55402-1110 Ph: (612) 338-5557 |
| NPI Number | 1689741787 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689741787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Minnesota) | Primary |
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