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Organization
ORAL AND MAXILLOFACIAL SURGICAL CONSULTANTS PA
Active
Organization
ORAL AND MAXILLOFACIAL SURGICAL CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBI A KECKHAFER (PRACTICE MANAGER)
(952) 841-9658
Entity
Organization
Contact information
Practice address
250 CENTRAL AVE N, SUITE126, WAYZATA, MN 55391-1206
(952) 475-2266
(952) 475-0637
Mailing address
250 CENTRAL AVE N, SUITE126, WAYZATA, MN 55391-1206
(952) 475-2266
(952) 475-0637
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
04/20/2007
Last updated
06/25/2015
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