Organization
ELK PLAZA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JOHN HICKEY D.D.S. (OWNER)
(763) 441-4200
Entity
Organization
Contact information
Practice address
501 MAIN ST NW, #101, ELK RIVER, MN 55330-1880
(763) 441-4200
Mailing address
501 MAIN ST NW, #101, ELK RIVER, MN 55330-1880
(763) 441-4200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8940
MN
Other
Enumeration date
08/30/2006
Last updated
08/22/2020
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