Organization
BROOK WEST FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN K JOHNSON (BUSINESS MANAGER)
(763) 561-2273
Entity
Organization
Contact information
Practice address
7950 MAIN ST, #205, MAPLE GROVE, MN 55369
(763) 561-2273
(763) 561-5761
Mailing address
7950 MAIN ST, #205, MAPLE GROVE, MN 55369
(763) 561-2273
(763) 561-5761
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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