Organization
SOUTHERN MINNESOTA PERIODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGEY BORISOVICH DOLGOV (OWNER)
(786) 487-1190
Entity
Organization
Contact information
Practice address
99 NAVAHO AVE, SUITE #102, MANKATO, MN 56001-4876
(507) 345-7537
(507) 345-7538
Mailing address
99 NAVAHO AVE, SUITE #102, MANKATO, MN 56001-4876
(507) 345-7537
(507) 345-7538
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/21/2016
Last updated
07/22/2016
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