Organization
SOUTHDALE PERIODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL ALLEN DYLLA D.D.S. (OWNER)
(952) 922-6949
Entity
Organization
Contact information
Practice address
6545 FRANCE AVE S, SUITE 190, EDINA, MN 55435-2131
(952) 922-6949
(952) 922-9287
Mailing address
6545 FRANCE AVE S, SUITE 190, EDINA, MN 55435-2131
(952) 922-6949
(952) 922-9287
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D12016
MN
Other
Enumeration date
04/01/2014
Last updated
04/01/2014
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