Organization
DENTAL SPECIALIST OF MINNESOTA, PLLC
Active
Other names
The Dental Specialist Deephaven
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON HESSE (CREDENTIALING SPECIALIST)
(651) 746-2815
Entity
Organization
Contact information
Practice address
18258 MINNETONKA BLVD STE 100, WAYZATA, MN 55391-3324
(952) 926-2761
Mailing address
2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551
(651) 746-2815
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/29/2020
Last updated
07/29/2020
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