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Organization
NORTH ST. PAUL DENTAL
Active
Organization
NORTH ST. PAUL DENTAL
Active
Parent organization
MAHTOMEDI DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAHTOMEDI DENTAL CLINIC
Authorized official
DR. TIMOTHY A BRAY DDS (OWNER/ DENTIST)
(651) 770-6260
Entity
Organization
Contact information
Practice address
2082 11TH AVE E, NORTH ST PAUL, MN 55109-5112
(651) 770-6260
Mailing address
814 MAHTOMEDI AVE, MAHTOMEDI, MN 55115-1730
(651) 426-0011
(651) 426-2075
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8217
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
982017500
—
MN
Enumeration date
12/17/2008
Last updated
12/17/2008
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