| Wooddale Dental Center, Llc | |
|
3401 Wooddale Ave S Ste 1 St Louis Park MN 55416-2341 | |
| (952) 929-3336 | |
| (952) 929-3338 |
| Full Name | Wooddale Dental Center, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3401 Wooddale Ave S Ste 1, St Louis Park, Minnesota |
| Authorized Official Name and Position | Jelena R Simic (DENTIST) |
| Authorized Official Contact | 9529293336 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wooddale Dental Center, Llc 3401 Wooddale Ave S Ste 1 St Louis Park MN 55416-2341 Ph: (952) 929-3336 | Wooddale Dental Center, Llc 3401 Wooddale Ave S Ste 1 St Louis Park MN 55416-2341 Ph: (952) 929-3336 |
| NPI Number | 1881972560 |
|---|---|
| Provider Enumeration Date | 07/28/2011 |
| Last Update Date | 07/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881972560 | NPI | - | NPPES |
| 1437219813 | Other | MN | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D12163 (Minnesota) | Primary |
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