Organization
PROSTHODONTIC ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON CHONG DDS (PARTNER)
(651) 633-4914
Entity
Organization
Contact information
Practice address
2233 HAMLINE AVE N, SUITE 210, ROSEVILLE, MN 55113-5009
(651) 633-4914
(651) 633-5126
Mailing address
2233 HAMLINE AVE N, SUITE 210, ROSEVILLE, MN 55113-5009
(651) 633-4914
(651) 633-5126
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D12653
MN
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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