| Tangletown Dental | |
|
4831 Nicollet Ave Minneapolis MN 55419-5534 | |
| (612) 822-2324 | |
| (612) 822-6763 |
| Full Name | Tangletown Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4831 Nicollet Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Brad S Isaacson (OWNER) |
| Authorized Official Contact | 6128222324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tangletown Dental 4831 Nicollet Ave Minneapolis MN 55419-5534 Ph: (612) 822-2324 | Tangletown Dental 4831 Nicollet Ave Minneapolis MN 55419-5534 Ph: (612) 822-2324 |
| NPI Number | 1942408778 |
|---|---|
| Provider Enumeration Date | 07/03/2007 |
| Last Update Date | 01/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942408778 | NPI | - | NPPES |
| 1427062819 | Other | INDIVIDUAL NPI | |
| 3018382 | Medicaid | MN | |
| 08320 | Other | MN | DELTA DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 08320 (Minnesota) | Primary |
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