Organization
STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET
Active
Parent organization
STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET
Other names
MINNESOTA VETERANS HOMES DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET
Authorized official
SIMONE RENEE HOGAN (MDVA CHIEF OPERATIONS DIRECTOR)
(612) 505-4110
Entity
Organization
Contact information
Practice address
2190 WILLIAM AVE, MONTEVIDEO, MN 56265-2273
(651) 396-6260
Mailing address
5101 MINNEHAHA AVE BLDG 10, MINNEAPOLIS, MN 55417-1647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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