Organization
NORTHWEST FAMILY DENTAL CENTER TN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A. DESIMONE D.D.S. (OWNER)
(763) 497-2367
Entity
Organization
Contact information
Practice address
12725 43RD ST NE, SUITE 202, SAINT MICHAEL, MN 55376-4900
(763) 497-2367
(763) 497-8171
Mailing address
12725 43RD ST NE, SUITE 202, SAINT MICHAEL, MN 55376-4900
(763) 497-2367
(763) 497-8171
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8424
MN
Other
Enumeration date
05/07/2007
Last updated
08/22/2020
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