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7373 147th St. W. #116 Apple Valley MN 55124 | |
| (952) 432-8110 | |
| (952) 432-4457 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 7373 147th St. W. #116, Apple Valley, Minnesota |
| Authorized Official Name and Position | Jeffrey Wichmann (OWNER) |
| Authorized Official Contact | 9524328110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7373 147th St. W. #116 Apple Valley MN 55124 Ph: (952) 432-8110 | 7373 147th St. W. #116 Apple Valley MN 55124 Ph: (952) 432-8110 |
| NPI Number | 1417101601 |
|---|---|
| Provider Enumeration Date | 11/14/2008 |
| Last Update Date | 04/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417101601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12069 (Minnesota) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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