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Organization
CHICAGO DENTISTS
Active
Organization
CHICAGO DENTISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NOEL KORENGOLD (BUSINESS MANAGER)
(612) 870-4646
Entity
Organization
Contact information
Practice address
2120 NICOLLET AVE, MINNEAPOLIS, MN 55404-2528
(612) 870-4646
(612) 870-7870
Mailing address
2120 NICOLLET AVE, MINNEAPOLIS, MN 55404-2528
(612) 870-4646
(612) 870-7870
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9164
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408522100
—
MN
Enumeration date
10/27/2006
Last updated
07/14/2008
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