Organization
WEST RIVER DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PAUL SKADRON D.D.S. (OWNER)
(612) 721-2424
Entity
Organization
Contact information
Practice address
4103 E LAKE ST, MINNEAPOLIS, MN 55406-2259
(612) 721-2424
(612) 721-3054
Mailing address
4103 E LAKE ST, MINNEAPOLIS, MN 55406-2259
(612) 721-2424
(612) 721-3054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10636
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7B839SK
BCBS PROVIDER #
MN
Enumeration date
08/19/2006
Last updated
08/22/2020
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