| St. Paul Oral Surgery, P.a. | |
|
710 19th Ave N Suite 300 South St Paul MN 55075-1359 | |
| (651) 451-1873 | |
| (651) 451-8010 |
| Full Name | St. Paul Oral Surgery, P.a. |
|---|---|
| Speciality | Dentist |
| Location | 710 19th Ave N, South St Paul, Minnesota |
| Authorized Official Name and Position | Dale Victor Olson (PRESIDENT) |
| Authorized Official Contact | 6514511873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Paul Oral Surgery, P.a. 710 19th Ave N Suite 300 South St Paul MN 55075-1359 Ph: (651) 451-1873 | St. Paul Oral Surgery, P.a. 710 19th Ave N Suite 300 South St Paul MN 55075-1359 Ph: (651) 451-1873 |
| NPI Number | 1548218910 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5597724419 |
|---|---|
| Medicare Enrollment ID | O20041006001243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548218910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7933 (Minnesota) | Primary |
| Provider Name | Charles J Tentinger |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1528151354 PECOS PAC ID: 8729051503 Enrollment ID: I20041006001297 |
| Provider Name | Christopher J French |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1427029073 PECOS PAC ID: 4486672573 Enrollment ID: I20051107001143 |
| Provider Name | Matthew J Hutchinson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1497073969 PECOS PAC ID: 5496947129 Enrollment ID: I20101013000128 |
Dental South Pa Dental Clinic Medicare: Medicare Enrolled Practice Location: 800 Marie Avenue, South St Paul, MN 55075 Phone: 651-451-1277 Fax: 651-455-8488 |