Individual
DR. JACK LOUIS CHURCHILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
825 NICOLLET MALL, 1427 MEDICAL ARTS BLDG, MINNEAPOLIS, MN 55402-2606
(612) 333-8988
(612) 339-3618
Mailing address
14615 13TH PL N, PLYMOUTH, MN 55447-4526
(763) 475-3710
(763) 475-2784
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8747
MN
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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