Organization
TWIN CITIES ORAL & MAXILLOFACIAL SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY HERDING (OFFICE MANAGER)
(952) 432-1514
Entity
Organization
Contact information
Practice address
14635 PENNOCK AVE, #250, APPLE VALLEY, MN 55124-6430
(952) 432-1514
Mailing address
925 HIGHWAY 55, STE 202, HASTINGS, MN 55033-3734
(651) 437-3262
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
05/29/2007
Last updated
08/22/2020
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