Organization
G2 SOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY M KOCTT (PRACTICE MANAGER)
(651) 389-1133
Entity
Organization
Contact information
Practice address
5846 BLACKSHIRE PATH, INVER GROVE HEIGHTS, MN 55016
(651) 389-1133
(651) 389-1135
Mailing address
5846 BLACKSHIRE PATH, INVER GROVE HEIGHTS, MN 55016
(651) 389-1133
(651) 389-1135
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8109
MN
122300000X
Dentist
9975
MN
Other
Enumeration date
11/09/2005
Last updated
08/22/2020
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