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200 Coon Rapids Blvd Nw Coon Rapids MN 55433-5876 | |
| (763) 786-9457 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 200 Coon Rapids Blvd Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Karie T Graden (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9524321103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14605 Glazier Ave Apple Valley MN 55124-7545 Ph: () - | 200 Coon Rapids Blvd Nw Coon Rapids MN 55433-5876 Ph: (763) 786-9457 |
| NPI Number | 1194849661 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194849661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (Minnesota) | Primary |
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