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Organization
PDB, DDS, PA
Active
Organization
PDB, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BOETTNER DDS (CEO)
(763) 476-6774
Entity
Organization
Contact information
Practice address
12736 BASS LAKE RD, MAPLE GROVE, MN 55369-6307
(763) 559-2082
Mailing address
1485 COUNTY ROAD 101 N, PLYMOUTH, MN 55447-3053
(763) 476-6774
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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