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8325 Wayzata Blvd Ste 150 Golden Valley MN 55426-1398 | |
| (763) 417-9975 | |
| (763) 417-9976 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 8325 Wayzata Blvd Ste 150, Golden Valley, Minnesota |
| Authorized Official Name and Position | Christina Moody (OFFICE MANAGER) |
| Authorized Official Contact | 6057165622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8325 Wayzata Blvd Ste 150 Golden Valley MN 55426-1398 Ph: (763) 417-9975 | 8325 Wayzata Blvd Ste 150 Golden Valley MN 55426-1398 Ph: (763) 417-9975 |
| NPI Number | 1316210347 |
|---|---|
| Provider Enumeration Date | 02/22/2012 |
| Last Update Date | 02/22/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316210347 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D8779 (Minnesota) | Primary |
| 122300000X | Dentist | D12070 (Minnesota) | Secondary |
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