Organization
GROVE DENTIST PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENY CHACKO (DENTIST)
(651) 308-2804
Entity
Organization
Contact information
Practice address
13649 GROVE DR, MAPLE GROVE, MN 55311-4405
(763) 420-8038
(763) 494-4222
Mailing address
13649 GROVE DR, MAPLE GROVE, MN 55311-4405
(763) 420-8038
(763) 494-4222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11844
MN
Other
Enumeration date
04/10/2013
Last updated
04/10/2013
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