Organization
GROVELAND DENTAL P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW COLAIZY (PRESIDENT)
(651) 298-0024
Entity
Organization
Contact information
Practice address
2042 SAINT CLAIR AVE, SAINT PAUL, MN 55105-1650
(651) 298-0024
(651) 695-2333
Mailing address
2042 SAINT CLAIR AVE, SAINT PAUL, MN 55105-1650
(651) 298-0024
(651) 695-2333
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11657
MN
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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