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14990 Glazier Ave Suite 100 Apple Valley MN 55124-7818 | |
| (952) 431-5114 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 14990 Glazier Ave, Apple Valley, Minnesota |
| Authorized Official Name and Position | John Gulon (PRESIDENT) |
| Authorized Official Contact | 9529492536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3030 Centre Pointe Dr Suite 100 Roseville MN 55113-1112 Ph: (651) 286-8100 | 14990 Glazier Ave Suite 100 Apple Valley MN 55124-7818 Ph: (952) 431-5114 |
| NPI Number | 1841366093 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841366093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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