Organization
ASSOCIATED DENTISTS SHOLOM HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE LOFT (SITE MANAGER)
(651) 488-5557
Entity
Organization
Contact information
Practice address
1371 7TH ST W, SUITE B, SAINT PAUL, MN 55102-4205
(651) 488-5557
(651) 488-0014
Mailing address
1371 7TH ST W, SUITE B, SAINT PAUL, MN 55102-4205
(651) 488-5557
(651) 488-0014
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11152
MN
1223G0001X
General Practice Dentistry
Primary
D11202
MN
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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