Organization
EDP OF MINNESOTA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEANNE BRUNENKANT (DIRECTOR OF INTEGRATIONS)
(312) 937-3619
Entity
Organization
Contact information
Practice address
5820 74TH AVE N STE 110, BROOKLYN PARK, MN 55443-3140
(736) 561-7000
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 937-3619
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2018
Last updated
09/16/2019
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