Organization
WOODDALE DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JELENA R SIMIC DDS (DENTIST)
(952) 929-3336
Entity
Organization
Contact information
Practice address
3401 WOODDALE AVE S STE 1, ST LOUIS PARK, MN 55416-2341
(952) 929-3336
(952) 929-3338
Mailing address
3401 WOODDALE AVE S STE 1, ST LOUIS PARK, MN 55416-2341
(952) 929-3336
(952) 929-3338
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D12163
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437219813
NPI TYPE 1
MN
Enumeration date
07/28/2011
Last updated
07/28/2011
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