Organization
THE GORMAN CENTER FOR FINE DEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE SAMUELSON (ADMINISTRATOR)
(612) 703-0118
Entity
Organization
Contact information
Practice address
700 VILLAGE CENTER DR, STE 100, NORTH OAKS, MN 55127-5512
(651) 483-5134
Mailing address
700 VILLAGE CENTER DRIVE, STE.,100, NORTH OAKS, MN 55127-3020
(651) 483-5134
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D14693
NPI
MN
Enumeration date
11/08/2022
Last updated
11/08/2022
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