Organization
GRAND AVENUE DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT S TYLER (BUSINESS MANAGER)
(651) 291-9667
Entity
Organization
Contact information
Practice address
960 GRAND AVE, SAINT PAUL, MN 55105-3014
(651) 291-9667
Mailing address
960 GRAND AVE, SAINT PAUL, MN 55105-3014
(651) 291-9667
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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