Organization
MANKATO FAMILY DENTAL, P.A.
Active
Other names
Broad Street Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER KELLY MEEHAN DDS (DDS/OWNER)
(507) 345-4259
Entity
Organization
Contact information
Practice address
151 ST ANDREWS CT STE 1120, MANKATO, MN 56001
(507) 345-4259
(507) 345-4460
Mailing address
151 ST ANDREWS CT STE 1120, MANKATO, MN 56001
(507) 345-4259
(507) 345-4460
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10009
MN
1223G0001X
General Practice Dentistry
12148
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285610022
INDIVIDUAL UNDER CORPORAT
MN
01
—
1770572877
OTHER PROVIDER UNDER CORP
MN
Enumeration date
08/23/2006
Last updated
05/03/2016
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