Organization
PERSONAL CARE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY G. FULTON (MGR)
(651) 636-0655
Entity
Organization
Contact information
Practice address
2233 HAMLINE AVE N STE 320, ROSEVILLE, MN 55113-5005
(651) 636-0655
Mailing address
2233 HAMLINE AVE N STE 320, ROSEVILLE, MN 55113-5005
(651) 636-0655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154427276
DR. MICHEAL FUREY
MN
01
—
1386050599
DR. KYLE NPI
MN
01
—
1568876514
DR. ANDREW HEINISCH NPI
MN
01
—
1851490585
DR. DANIEL SHANNON NPI
MN
Enumeration date
10/29/2019
Last updated
10/29/2019
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