Organization
MICHAEL K SUTLEY DDS PA
Active
Other names
minneapolis oral & maxillofacial surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL K SUTLEY DDS (PRESIDENT)
(612) 333-3381
Entity
Organization
Contact information
Practice address
825 NICOLLET MALL, SUITE 707 MEDICAL ARTS BUILDING, MINNEAPOLIS, MN 55402-2606
(612) 333-3381
(612) 334-3318
Mailing address
825 NICOLLET MALL, SUITE 707 MEDICAL ARTS BUILDING, MINNEAPOLIS, MN 55402-2606
(612) 333-3381
(612) 334-3318
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9086
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01007972
PREFERRED ONE
MN
01
—
41426OR
BLUE CROSS BLUE SHIELD
MN
01
—
8080107
MEDICA MEDICAL
MN
01
—
8622286
MEDICA DENTAL
MN
Enumeration date
02/20/2007
Last updated
08/22/2020
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