Organization
STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET
Active
Parent organization
STATE OF MINNESOTA MINNESOTA MANAGE
Other names
Minnesota Veterans Homes Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MINNESOTA MINNESOTA MANAGE
Authorized official
SIMONE RENEE HOGAN (MDVA CHIEF OPERATIONS DIRECTOR)
(612) 505-4110
Entity
Organization
Contact information
Practice address
56 OUTER DR, SILVER BAY, MN 55614-1133
(218) 353-8700
(612) 548-5964
Mailing address
5101 MINNEHAHA AVE. S, MINNEAPOLIS, MN 55417-1647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/07/2023
Last updated
12/03/2024
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