Organization
MDO PERIODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE GRUNDHOEFER (OFFICE MANAGER)
(320) 240-9028
Entity
Organization
Contact information
Practice address
1900 KRUCHTEN CT S, STE. 101, SARTELL, MN 56377-4730
(320) 240-9028
(320) 240-9048
Mailing address
1900 KRUCHTEN CT S, STE. 101, SARTELL, MN 56377-4730
(320) 240-9028
(320) 240-9048
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
11/20/2008
Last updated
11/20/2008
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