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16795 County Road 24 Suite 6 Plymouth MN 55447-1201 | |
| (763) 577-9840 | |
| (763) 577-9843 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 16795 County Road 24, Plymouth, Minnesota |
| Authorized Official Name and Position | Carl Benton Fitzsimmons (PRESIDENT/CEO) |
| Authorized Official Contact | 7635779840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16795 County Road 24 Suite 6 Plymouth MN 55447-1201 Ph: (763) 577-9840 | 16795 County Road 24 Suite 6 Plymouth MN 55447-1201 Ph: (763) 577-9840 |
| NPI Number | 1972894061 |
|---|---|
| Provider Enumeration Date | 04/25/2011 |
| Last Update Date | 04/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972894061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D11044 (Minnesota) | Primary |
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