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12904 Central Ave. Ne Blaine MN 55434 | |
| (651) 746-0587 | |
| (651) 636-1118 |
| Full Name | |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 12904 Central Ave. Ne, Blaine, Minnesota |
| Authorized Official Name and Position | Alan Law (PRESIDENT) |
| Authorized Official Contact | 6516330500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2200 County Road C West Suite 2210 Roseville MN 55113 Ph: (651) 633-0500 | 12904 Central Ave. Ne Blaine MN 55434 Ph: (651) 746-0587 |
| NPI Number | 1922308113 |
|---|---|
| Provider Enumeration Date | 10/22/2010 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922308113 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
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