Individual
DR. GREGORY JOHN POVOLNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9120 BALTIMORE ST NE, BLAINE, MN 55449-4337
(763) 786-1560
(763) 786-4390
Mailing address
3527 GLEN OAKS AVE, WHITE BEAR LAKE, MN 55110-5661
(651) 777-8427
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8811
MN
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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