| Southdale Periodontics, Pllc | |
|
6545 France Ave S Suite 190 Edina MN 55435-2131 | |
| (952) 922-6949 | |
| (952) 922-9287 |
| Full Name | Southdale Periodontics, Pllc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 6545 France Ave S, Edina, Minnesota |
| Authorized Official Name and Position | Russell Allen Dylla (OWNER) |
| Authorized Official Contact | 9529226949 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southdale Periodontics, Pllc 6545 France Ave S Suite 190 Edina MN 55435-2131 Ph: (952) 922-6949 | Southdale Periodontics, Pllc 6545 France Ave S Suite 190 Edina MN 55435-2131 Ph: (952) 922-6949 |
| NPI Number | 1134547730 |
|---|---|
| Provider Enumeration Date | 04/01/2014 |
| Last Update Date | 04/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134547730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | D12016 (Minnesota) | Primary |
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