| Southern Heights Dental Group Pa | |
|
1575 20th Street Northwest Suite 102 Faribault MN 55021 | |
| (507) 334-6433 | |
| (507) 334-0044 |
| Full Name | Southern Heights Dental Group Pa |
|---|---|
| Speciality | Dentist |
| Location | 1575 20th Street Northwest, Faribault, Minnesota |
| Authorized Official Name and Position | Kate Tonjum (ADMINISTRATOR) |
| Authorized Official Contact | 5073346433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Heights Dental Group Pa 1575 20th Street Northwest Suite 102 Faribault MN 55021 Ph: (507) 334-6433 | Southern Heights Dental Group Pa 1575 20th Street Northwest Suite 102 Faribault MN 55021 Ph: (507) 334-6433 |
| NPI Number | 1932247921 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 08/06/2020 |
| Medicare PECOS PAC ID | 4981900271 |
|---|---|
| Medicare Enrollment ID | O20160314000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932247921 | NPI | - | NPPES |
| 550722700 | Medicaid | MN | |
| 607320400 | Medicaid | MN | |
| 148427300 | Medicaid | MN | |
| 284735300 | Medicaid | MN | |
| 856415900 | Medicaid | MN | |
| 325522100 | Medicaid | MN | |
| 440217100 | Medicaid | MN | |
| 443655000 | Medicaid | MN | |
| 849698600 | Medicaid | MN |
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