Organization
EAGAN VALLEY DENTAL CENTER P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAVID MITTELSTEADT (PRESIDENT)
(651) 681-9044
Entity
Organization
Contact information
Practice address
4555 ERIN DR, EAGAN, MN 55122-3398
(651) 681-9044
(651) 681-0599
Mailing address
4555 ERIN DR, EAGAN, MN 55122-3398
(651) 681-9044
(651) 681-0599
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
09922
MN
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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