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800 W Broadway Ave Minneapolis MN 55411-2614 | |
| (612) 543-2900 | |
| (612) 288-2909 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 800 W Broadway Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Baye D Diouf (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6125432545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1256 Penn Ave N Ste 5100 Minneapolis MN 55411-2617 Ph: (612) 543-2545 | 800 W Broadway Ave Minneapolis MN 55411-2614 Ph: (612) 543-2900 |
| NPI Number | 1407373202 |
|---|---|
| Provider Enumeration Date | 08/23/2017 |
| Last Update Date | 09/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407373202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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