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Organization
PRAIRIE DENTAL GROUP
Active
Organization
PRAIRIE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARYL LEACH (ADMINISTRATOR)
(952) 903-5000
Entity
Organization
Contact information
Practice address
6608 FLYING CLOUD DR, EDEN PRAIRIE, MN 55344-3381
(952) 903-5000
(952) 944-0642
Mailing address
6608 FLYING CLOUD DR, EDEN PRAIRIE, MN 55344-3381
(952) 903-5000
(952) 944-0642
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
07/28/2009
Last updated
07/28/2009
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