Organization
OSAGE DENTAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY SHADRICK (OM)
(763) 757-6600
Entity
Organization
Contact information
Practice address
11441 OSAGE ST NW, COON RAPIDS, MN 55433-3677
(763) 757-6600
(763) 757-3693
Mailing address
11441 OSAGE ST NW, COON RAPIDS, MN 55433-3677
(763) 757-6600
(763) 757-3693
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9770
MN
Other
Enumeration date
01/22/2007
Last updated
08/22/2020
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