| Pdb, Dds, Pa | |
|
12736 Bass Lake Rd Maple Grove MN 55369-6307 | |
| (763) 559-2082 | |
| Not Available |
| Full Name | Pdb, Dds, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12736 Bass Lake Rd, Maple Grove, Minnesota |
| Authorized Official Name and Position | Paul Boettner (CEO) |
| Authorized Official Contact | 7634766774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pdb, Dds, Pa 1485 County Road 101 N Plymouth MN 55447-3053 Ph: (763) 476-6774 | Pdb, Dds, Pa 12736 Bass Lake Rd Maple Grove MN 55369-6307 Ph: (763) 559-2082 |
| NPI Number | 1942809637 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 10/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942809637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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