| Wilder Senior Dental Clinic | |
|
516 Humboldt Ave Saint Paul MN 55107 | |
| (651) 220-1807 | |
| Not Available |
| Full Name | Wilder Senior Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 516 Humboldt Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Craig Binger (VICE PRESIDENT ADMINISTRATION) |
| Authorized Official Contact | 6516424000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilder Senior Dental Clinic 650 Marshall Ave Saint Paul MN 55104-6644 Ph: () - | Wilder Senior Dental Clinic 516 Humboldt Ave Saint Paul MN 55107 Ph: (651) 220-1807 |
| NPI Number | 1407914674 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407914674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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