| Proactive Dental Clinic Corp | |
|
334 E Lake St Ste 105 Minneapolis MN 55408-2485 | |
| (310) 883-8932 | |
| Not Available |
| Full Name | Proactive Dental Clinic Corp |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 334 E Lake St Ste 105, Minneapolis, Minnesota |
| Authorized Official Name and Position | Solaman Shire (OWNER) |
| Authorized Official Contact | 3108838932 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Dental Clinic Corp 334 E Lake St Ste 105 Minneapolis MN 55408-2485 Ph: () - | Proactive Dental Clinic Corp 334 E Lake St Ste 105 Minneapolis MN 55408-2485 Ph: (310) 883-8932 |
| NPI Number | 1003654104 |
|---|---|
| Provider Enumeration Date | 07/15/2024 |
| Last Update Date | 07/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003654104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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