| Pl Dental Sc | |
|
12628 Fremont Ave Zimmerman MN 55398-9735 | |
| (833) 217-5959 | |
| Not Available |
| Full Name | Pl Dental Sc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12628 Fremont Ave, Zimmerman, Minnesota |
| Authorized Official Name and Position | Phong Vinh Ly (OWNER) |
| Authorized Official Contact | 7633171168 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pl Dental Sc 9920 Foley Blvd Nw Ste 110 Coon Rapids MN 55433-5216 Ph: (633) 171-1667 | Pl Dental Sc 12628 Fremont Ave Zimmerman MN 55398-9735 Ph: (833) 217-5959 |
| NPI Number | 1225786411 |
|---|---|
| Provider Enumeration Date | 03/16/2022 |
| Last Update Date | 05/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225786411 | NPI | - | NPPES |
| 1790131791 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Pine Ridge Dental Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 26273 2nd St E, Suite A, Zimmerman, MN 55398 Phone: 763-856-5100 Fax: 763-856-0366 |