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Organization

DAKOTA VALLEY ORAL AND MAXILLOFACIAL SURGERY, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE HARTMANN (CLINIC MANAGER)
(651) 905-4834
Entity
Organization

Contact information

Practice address
2130 CLIFF RD, SUITE 100, SAINT PAUL, MN 55122-2485
(651) 452-6933
Mailing address
2130 CLIFF RD, SUITE 100, SAINT PAUL, MN 55122-2485
(651) 452-6933

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6B354SE
BCBS MN CLINIC NUMBER
MN
Enumeration date
03/22/2007
Last updated
07/06/2020
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