Organization
FAMILY DENTAL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD SORENSON D.D.S. (PRESIDENT)
(612) 823-6262
Entity
Organization
Contact information
Practice address
4454 CHICAGO AVE, MINNEAPOLIS, MN 55407-3522
(612) 823-6262
(612) 823-6783
Mailing address
4454 CHICAGO AVE, MINNEAPOLIS, MN 55407-3522
(612) 823-6262
(612) 823-6783
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7605
MN
Other
Enumeration date
01/23/2007
Last updated
08/22/2020
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