| West Side Dental Clinic | |
|
478 Robert St S Saint Paul MN 55107-2236 | |
| (651) 602-7575 | |
| (651) 602-7518 |
| Full Name | West Side Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 478 Robert St S, Saint Paul, Minnesota |
| Authorized Official Name and Position | Reuben Moore (CEO) |
| Authorized Official Contact | 6516027500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Side Dental Clinic 153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 602-7500 | West Side Dental Clinic 478 Robert St S Saint Paul MN 55107-2236 Ph: (651) 602-7575 |
| NPI Number | 1417007436 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417007436 | NPI | - | NPPES |
| 250711100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 302133 (Minnesota) | Primary |
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