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11855 Ulysses St Ne Ste 260 Blaine MN 55434-4182 | |
| (763) 767-9119 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 11855 Ulysses St Ne Ste 260, Blaine, Minnesota |
| Authorized Official Name and Position | Katie Klein (BUSSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7637679119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11855 Ulysses St Ne Ste 260 Blaine MN 55434-4182 Ph: (763) 767-9119 | 11855 Ulysses St Ne Ste 260 Blaine MN 55434-4182 Ph: (763) 767-9119 |
| NPI Number | 1790389005 |
|---|---|
| Provider Enumeration Date | 11/27/2020 |
| Last Update Date | 11/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790389005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
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