| Wellstone Dental Clinic | |
|
3328 Elliot Ave S Minneapolis MN 55407-2125 | |
| (612) 332-4973 | |
| Not Available |
| Full Name | Wellstone Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 3328 Elliot Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Sahra Noor (CEO) |
| Authorized Official Contact | 6123324973 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellstone Dental Clinic 425 20th Ave S Minneapolis MN 55454-4400 Ph: (612) 332-4973 | Wellstone Dental Clinic 3328 Elliot Ave S Minneapolis MN 55407-2125 Ph: (612) 332-4973 |
| NPI Number | 1780133983 |
|---|---|
| Provider Enumeration Date | 09/28/2016 |
| Last Update Date | 09/28/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780133983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Minnesota) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
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