| Willow Grove Family Dental | |
|
28 Nathan Ln N Plymouth MN 55441-6306 | |
| (763) 544-5555 | |
| (763) 544-0305 |
| Full Name | Willow Grove Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 28 Nathan Ln N, Plymouth, Minnesota |
| Authorized Official Name and Position | Alex Grudsky (OWNER - PRESIDENT) |
| Authorized Official Contact | 7636940222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Grove Family Dental 28 Nathan Ln N Plymouth MN 55441-6306 Ph: (763) 544-5555 | Willow Grove Family Dental 28 Nathan Ln N Plymouth MN 55441-6306 Ph: (763) 544-5555 |
| NPI Number | 1417399965 |
|---|---|
| Provider Enumeration Date | 07/25/2013 |
| Last Update Date | 06/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417399965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Minnesota) | Primary |
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