Organization
ENDODONTIC PROFESSIONALS PA - ST ANTHONY ENDODONTICS
Active
Parent organization
ENDODONTIC PROFESSIONALS PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
ENDODONTIC PROFESSIONALS PA
Authorized official
DR. MARK R JENSEN DDS (PRESIDENT)
(763) 559-0859
Entity
Organization
Contact information
Practice address
3905 SILVER LAKE RD NE, MINNEAPOLIS, MN 55421-4352
(763) 559-0859
(763) 559-4356
Mailing address
3401 HIGHWAY 169 N, PLYMOUTH, MN 55441-2413
(763) 559-0859
(763) 559-4356
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
07/24/2014
Last updated
07/24/2014
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