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800 Lasalle Ave Suite 100 Minneapolis MN 55402-2006 | |
| (612) 338-4546 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 800 Lasalle Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | John Gulon (PRESIDENT) |
| Authorized Official Contact | 6516330500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2200 County Road C W Suite 2210 Roseville MN 55113-2504 Ph: (651) 633-0500 | 800 Lasalle Ave Suite 100 Minneapolis MN 55402-2006 Ph: (612) 338-4546 |
| NPI Number | 1184782617 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184782617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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