Organization
UNIVERSITY OF MINNESOTA PHYSICIANS
Active
Other names
Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOHNSON COO (CHIEF OPERATING OFFICER)
(612) 884-0802
Entity
Organization
Contact information
Practice address
606 24TH AVE S, SUITE 200, MINNEAPOLIS, MN 55454-1455
(812) 659-8689
(612) 659-8690
Mailing address
606 24TH AVE S, SUITE 200, MINNEAPOLIS, MN 55454-1455
(612) 659-8689
(612) 659-8690
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701372800
—
MN
Enumeration date
12/04/2008
Last updated
06/05/2013
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