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15535 34th Ave N Suite 250 Plymouth MN 55447-1481 | |
| (763) 233-3310 | |
| (763) 233-3312 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 15535 34th Ave N, Plymouth, 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 55113-2550 Ph: (651) 633-0500 | 15535 34th Ave N Suite 250 Plymouth MN 55447-1481 Ph: (763) 233-3310 |
| NPI Number | 1548687296 |
|---|---|
| Provider Enumeration Date | 03/19/2014 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548687296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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