Organization
MINNESOTA STATE COMMUNITY AND TECHNICAL COLLEGE - DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS L BOE DDS, MBA (DIRECTOR DENTAL DEPARTMEN)
(218) 299-6819
Entity
Organization
Contact information
Practice address
1900 28TH AVE S, MOORHEAD, MN 56560-4830
(218) 299-6560
(218) 299-6532
Mailing address
1900 28TH AVE S, MOORHEAD, MN 56560-4830
(218) 299-6560
(218) 299-6532
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041211
—
ND
Enumeration date
12/11/2006
Last updated
08/22/2020
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