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Organization
FOUR SEASONS DENTAL PA
Active
Organization
FOUR SEASONS DENTAL PA
Active
Other names
Four Seasons Dental PA
Organization subpart
No
Provider details
NPI number
Authorized official
KERSTEN HOFFMAN (CLINIC ADMINISTRATOR)
(952) 475-0225
Entity
Organization
Contact information
Practice address
4205 LANCASTER LN N STE 101, PLYMOUTH, MN 55441-1702
(763) 559-2976
(763) 559-4852
Mailing address
109 BUSHAWAY RD STE 300, WAYZATA, MN 55391-2079
(952) 475-0225
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/10/2018
Last updated
05/10/2018
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