Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
West Side Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (CEO)
(651) 602-7500
Entity
Organization
Contact information
Practice address
478 ROBERT ST S, SAINT PAUL, MN 55107-2236
(651) 602-7575
(651) 602-7518
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 602-7500
(651) 602-7500
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
302133
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250711100
—
MN
Enumeration date
01/11/2007
Last updated
05/15/2024
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