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Organization
THE DENTAL SPECIALIST OF MINNESOTA, PLLC
Active
Organization
THE DENTAL SPECIALIST OF MINNESOTA, PLLC
Active
Other names
The Dental Specialist St Croix Valley
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON HESSE (CREDENTIALING SPECIALIST)
(651) 746-2815
Entity
Organization
Contact information
Practice address
13961 60TH ST N, STILLWATER, MN 55082-1053
(651) 760-3681
(651) 760-3683
Mailing address
2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
10/28/2020
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