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Organization
MANKATO FAMILY DENTAL, P.A.
Active
Organization
MANKATO FAMILY DENTAL, P.A.
Active
Other names
Broad Street Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER KELLY MEEHAN DDS (DDS/OWNER)
(507) 345-4259
Entity
Organization
Contact information
Practice address
151 ST ANDREWS CT STE 1120, MANKATO, MN 56001
(507) 345-4259
(507) 345-4460
Mailing address
151 ST ANDREWS CT STE 1120, MANKATO, MN 56001
(507) 345-4259
(507) 345-4460
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10009
MN
1223G0001X
General Practice Dentistry
12148
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285610022
INDIVIDUAL UNDER CORPORAT
MN
01
—
1770572877
OTHER PROVIDER UNDER CORP
MN
Enumeration date
08/23/2006
Last updated
05/03/2016
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