| |
515 Delaware St Se 6-296 Moos Tower Minneapolis MN 55455-0357 | |
(612) 625-5945 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 515 Delaware St Se, Minneapolis, Minnesota |
Authorized Official Name and Position | Gary Carl Anderson (DEAN, UOFMN SCHOOL OF DENTISTRY) |
Authorized Official Contact | 6126266529 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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515 Delaware St Se 7-530 Moos Tower Minneapolis MN 55455-0357 Ph: (612) 625-5945 | 515 Delaware St Se 6-296 Moos Tower Minneapolis MN 55455-0357 Ph: (612) 625-5945 |
NPI Number | 1962520577 |
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Provider Enumeration Date | 03/26/2007 |
Last Update Date | 12/21/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962520577 | NPI | - | NPPES |
04-09573 | Other | MN | MEDICA |
1022170 | Other | MN | PREFERRED ONE |
126084 | Other | MN | UCARE MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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