Organization
MAHTOMEDI DENTAL CLINIC
Active
Other names
North St. Paul Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY A BRAY DDS MPH (OWNER - DENTIST)
(651) 426-0011
Entity
Organization
Contact information
Practice address
814 MAHTOMEDI AVE, MAHTOMEDI DENTAL, MAHTOMEDI, MN 55115-1730
(651) 426-0011
(651) 426-2075
Mailing address
814 MAHTOMEDI AVE, MAHTOMEDI, MN 55115-1730
(651) 426-0011
(651) 426-2075
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
11396
MN
1223G0001X
General Practice Dentistry
Primary
D8217
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
982017500
—
MN
Enumeration date
04/01/2008
Last updated
07/18/2008
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