# STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF MINNESOTA MINNESOTA MANAGE
- **Other names:** Minnesota Veterans Homes Dental Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588360903
- **Legal business name:** STATE OF MINNESOTA MINNESOTA MANAGE
- **Authorized official:** SIMONE RENEE HOGAN (MDVA HEALTHCARE OPERATIONS DIRECTOR)
- **Authorized official phone:** (612) 505-4110

## Contact information

- **Practice address:** 5101 MINNEHAHA AVE. S, MINNEAPOLIS, MN 55417-1647
- **Practice address phone:** (612) 548-5733
- **Practice address fax:** (612) 548-5964
- **Mailing address:** 5101 MINNEHAHA AVE. S, MINNEAPOLIS, MN 55417-1647

## Taxonomy

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

## Other

- **Enumeration date:** 02/07/2023
- **Last updated:** 12/03/2024