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Organization
DISTINCTIVE DENTAL SERVICES PA
Active
Organization
DISTINCTIVE DENTAL SERVICES PA
Active
Parent organization
DISTINCTIVE DENTAL SERVICES, PA
Other names
Hilltop Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DISTINCTIVE DENTAL SERVICES, PA
Authorized official
DR. MICHAEL JOHN THOENNES DDS (CEO)
(763) 572-9762
Entity
Organization
Contact information
Practice address
4716 CENTRAL AVE NE, HILLTOP, MN 55421-1944
(763) 572-9762
(763) 572-2827
Mailing address
4716 CENTRAL AVE NE, HILLTOP, MN 55421-1944
(763) 572-9762
(763) 572-2827
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D08971
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
949522300
—
MN
Enumeration date
07/17/2008
Last updated
07/17/2008
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