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Organization
PUBLIC HEALTH DENTAL LLC
Active
Organization
PUBLIC HEALTH DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAUREEN DERDIE O'SULLIVAN (ADVANCED DENTAL THERAPIST)
(612) 801-5203
Entity
Organization
Contact information
Practice address
385 S OWASSO BLVD W, ROSEVILLE, MN 55113-2119
(612) 801-5203
Mailing address
385 S OWASSO BLVD W, ROSEVILLE, MN 55113-2119
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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