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Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
West Side Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (CEO)
(651) 602-7500
Entity
Organization
Contact information
Practice address
478 ROBERT ST S, SAINT PAUL, MN 55107-2236
(651) 602-7575
(651) 602-7518
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 602-7500
(651) 602-7500
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
302133
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250711100
—
MN
Enumeration date
01/11/2007
Last updated
05/15/2024
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