# WOODDALE DENTAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356404883
- **Authorized official:** MICHAEL JAMES SPENCER (PRESIDENT)
- **Authorized official phone:** (952) 929-3336

## Contact information

- **Practice address:** 3401 WOODDALE AVE S, ST LOUIS PARK, MN 55416-2340
- **Practice address phone:** (952) 929-3336
- **Practice address fax:** (952) 929-3338
- **Mailing address:** 3401 WOODDALE AVE S, ST LOUIS PARK, MN 55416-2340
- **Mailing address phone:** (952) 929-3336
- **Mailing address fax:** (952) 929-3338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 08/22/2020