Organization
CENTRAL MN PEDIATRIC DENTISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH HALL WENNER DDS (PRESIDENT)
(320) 253-0272
Entity
Organization
Contact information
Practice address
1900 CENTRACARE CIRCLE, STE 0350, ST CLOUD, MN 56303-5000
(320) 253-0272
(320) 251-2661
Mailing address
1900 CENTRACARE CIRCLE, STE 0350, ST CLOUD, MN 56303-5000
(320) 253-0272
(320) 251-2661
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55520WE
BCBS
MN
05
—
678350300
—
MN
Enumeration date
05/31/2006
Last updated
06/18/2013
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