Organization
TWIN CITIES MODERN DENTISTRY PLLC
Active
Other names
twin cities modern dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RYAN HENRICKSON DDS (DENTIST)
(651) 777-8900
Entity
Organization
Contact information
Practice address
6600 CITY WEST PKWY, SUITE 315, EDEN PRAIRIE, MN 55344-3261
(952) 920-9411
Mailing address
6600 CITY WEST PKWY, SUITE 315, EDEN PRAIRIE, MN 55344-3261
(952) 920-9411
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11920
MN
Other
Enumeration date
06/19/2012
Last updated
07/13/2012
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