| Southern Minnesota Periodontics Pa | |
|
99 Navaho Ave Suite #102 Mankato MN 56001-4876 | |
| (507) 345-7537 | |
| (507) 345-7538 |
| Full Name | Southern Minnesota Periodontics Pa |
|---|---|
| Speciality | Dentist |
| Location | 99 Navaho Ave, Mankato, Minnesota |
| Authorized Official Name and Position | Sergey Borisovich Dolgov (OWNER) |
| Authorized Official Contact | 7864871190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Minnesota Periodontics Pa 99 Navaho Ave Suite #102 Mankato MN 56001-4876 Ph: (507) 345-7537 | Southern Minnesota Periodontics Pa 99 Navaho Ave Suite #102 Mankato MN 56001-4876 Ph: (507) 345-7537 |
| NPI Number | 1316390669 |
|---|---|
| Provider Enumeration Date | 07/21/2016 |
| Last Update Date | 07/22/2016 |
| Medicare PECOS PAC ID | 8022396555 |
|---|---|
| Medicare Enrollment ID | O20161103000601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316390669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
| Provider Name | Sergey B Dolgov |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1154715795 PECOS PAC ID: 0648580050 Enrollment ID: I20151113001063 |
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