Organization
DENTAL SOUTH PA
Active
Parent organization
DENTAL SOUTH PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SOUTH PA
Authorized official
MICHAEL J. PRUEHER D.D.S. (OWNER/DENTIST)
(651) 451-1277
Entity
Organization
Contact information
Practice address
800 MARIE AVENUE, SOUTH ST PAUL, MN 55075
(651) 451-1277
(651) 455-8488
Mailing address
800 MARIE AVENUE, SOUTH ST PAUL, MN 55075
(651) 451-1277
(651) 455-8488
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9619
MN
Other
Enumeration date
11/08/2006
Last updated
12/02/2019
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