Organization
RSS MINNESOTA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATISHA PEOPLES (ONBOARDING AND CREDENTIALING)
(817) 440-6060
Entity
Organization
Contact information
Practice address
7701 YORK AVE S STE 100, EDINA, MN 55435-5849
(952) 679-6520
(469) 466-6086
Mailing address
1050 TEXAN TRL STE 300, GRAPEVINE, TX 76051-3759
(817) 440-6060
(469) 466-6086
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D13755
PROFESSIONAL LICENSE
MN
Enumeration date
05/24/2018
Last updated
09/19/2018
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