Organization
MINNESOTA DENTAL PROFESSIONALS, P.C.
Active
Parent organization
MINNESOTA DENTAL PROFESSIONALS, P.C.
Other names
Southwest Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Authorized official
JESSICA BRITT (CREDENTIALING COORDINATOR)
(217) 540-8426
Entity
Organization
Contact information
Practice address
107 12TH ST SW STE 2, FOREST LAKE, MN 55025-1467
(612) 261-4998
Mailing address
107 12TH ST SW STE 2, FOREST LAKE, MN 55025-1467
(651) 964-2013
(651) 272-5323
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/20/2018
Last updated
12/17/2018
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