Organization
MAHTOMEDI FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN WELLE (DOCTOR)
(651) 426-0011
Entity
Organization
Contact information
Practice address
814 MAHTOMEDI AVE, MAHTOMEDI, MN 55115-1730
(651) 426-0011
Mailing address
814 MAHTOMEDI AVE, MAHTOMEDI, MN 55115-1730
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7721
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811212624
—
MN
Enumeration date
10/03/2013
Last updated
10/03/2013
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