Organization
MINNESOTA CRANIOFACIAL CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM MARIE LEDERMANN D.D.S. (DENTIST/OWNER)
(651) 642-1013
Entity
Organization
Contact information
Practice address
2550 UNIVERSITY AVE W, SUITE 143N, SAINT PAUL, MN 55114-1052
(651) 642-1013
(651) 642-0947
Mailing address
2550 UNIVERSITY AVE W, SUITE 143N, SAINT PAUL, MN 55114-1052
(651) 642-1013
(651) 642-0947
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
11715
MN
Other
Enumeration date
11/26/2012
Last updated
06/11/2015
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