Organization
TWIN CITIES DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY VASSEUR RDA (OFFICE MANAGER)
(612) 782-7000
Entity
Organization
Contact information
Practice address
3803 SILVER LAKE RD NE, MINNEAPOLIS, MN 55421-4574
(612) 782-7000
(612) 782-7005
Mailing address
3803 SILVER LAKE RD NE, MINNEAPOLIS, MN 55421-4574
(612) 782-7000
(612) 782-7005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D12034
MN
1223G0001X
General Practice Dentistry
Primary
D12142
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243672800
—
MN
05
—
937605400
—
MN
Enumeration date
05/16/2008
Last updated
05/16/2008
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