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Organization
MN DENTAL SERVICE PROVIDERS LLC
Active
Organization
MN DENTAL SERVICE PROVIDERS LLC
Active
Parent organization
MN DENTAL SERVICE PROVIDERS LLC
Other names
Associated Oral and Maxillofacial Surgeons
Organization subpart
Yes
Provider details
NPI number
Legal business name
MN DENTAL SERVICE PROVIDERS LLC
Authorized official
CHARLOTTE DASCH (DIRECTOR OF CRED AND PR)
(504) 638-0303
Entity
Organization
Contact information
Practice address
3833 COON RAPIDS BLVD NW STE 220, COON RAPIDS, MN 55433-2597
(763) 421-6271
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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