Organization
LICENSED DENTAL HYGIENE CARE
Active
Other names
Senior Mobile Dental Minnesota Ltd
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA MICHELLE VACHA R.D.H. (EXECUTIVE DIRECTOR)
(763) 545-7545
Entity
Organization
Contact information
Practice address
5201 EDEN AVE, SUITE 50, EDINA, MN 55436-2316
(763) 545-7545
(952) 929-2067
Mailing address
5201 EDEN AVE, SUITE 50, EDINA, MN 55436-2316
(763) 545-7545
(952) 929-2067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12696
MN
251V00000X
Voluntary or Charitable Agency
20071454175
CO
Other
Enumeration date
11/06/2014
Last updated
11/07/2014
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