Individual
MITCHELL LEE PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
15785 95TH AVE N, MAPLE GROVE, MN 55369-4404
(763) 233-4140
(763) 420-3158
Mailing address
15875 95TH AVENUE N, MAPLE GROVE, MN 55369
(763) 233-4140
(763) 420-3158
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
10211
MN
1223E0200X
Endodontics
3179
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391719255
DELTA DENTAL
MN
01
—
48114PA
BC/BS
MN
Enumeration date
08/22/2006
Last updated
07/30/2019
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