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2193 Silver Lake Rd Nw New Brighton MN 55112-5331 | |
| (651) 633-3116 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2193 Silver Lake Rd Nw, New Brighton, Minnesota |
| Authorized Official Name and Position | Matthew Douglas Berg (PRESIDENT) |
| Authorized Official Contact | 6512359227 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2193 Silver Lake Rd Nw New Brighton MN 55112-5331 Ph: (651) 633-3116 | 2193 Silver Lake Rd Nw New Brighton MN 55112-5331 Ph: (651) 633-3116 |
| NPI Number | 1063685493 |
|---|---|
| Provider Enumeration Date | 04/07/2008 |
| Last Update Date | 05/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063685493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D11937 (Minnesota) | Primary |
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