| Indian Health Board Dental | |
|
2020 Minnehaha Ave Minneapolis MN 55404-3104 | |
| (612) 721-9800 | |
| (612) 721-9870 |
| Full Name | Indian Health Board Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2020 Minnehaha Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Tia Shaw (HIM/BILLING MANAGER) |
| Authorized Official Contact | 6127219830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Health Board Dental 1315 E 24th St Minneapolis MN 55404-3975 Ph: (612) 721-9881 | Indian Health Board Dental 2020 Minnehaha Ave Minneapolis MN 55404-3104 Ph: (612) 721-9800 |
| NPI Number | 1578670188 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 06/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578670188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6115875 (Minnesota) | Primary |
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