Organization
BOREALIS DENTAL WYOMING PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN GOOLSBY DDS (PRESIDENT)
(651) 757-0482
Entity
Organization
Contact information
Practice address
26357 FOREST BLVD # 2, WYOMING, MN 55092-8353
(651) 462-7017
Mailing address
PO BOX 886, WYOMING, MN 55092-0886
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/21/2024
Last updated
11/05/2024
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