Organization
NOKOMIS FAMILY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM JACOBSON (BUSINESS MANAGER)
(952) 881-0504
Entity
Organization
Contact information
Practice address
4948 34TH AVE S, MINNEAPOLIS, MN 55417-1504
(612) 722-4676
Mailing address
8910 PENN AVE S, BLOOMINGTON, MN 55431-2025
(952) 881-0504
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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