Organization
MODERN DENTAL PROFESSIONALS, MINNESOTA PC
Active
Other names
Midwest Dental - South St. Paul
Organization subpart
No
Provider details
NPI number
Authorized official
LORI J PELKE (PROFESSIONAL SERVICES)
(715) 926-5050
Entity
Organization
Contact information
Practice address
680 SOUTHVIEW BLVD., SOUTH SAINT PAUL, MN 55075
(651) 455-2297
(651) 455-9223
Mailing address
680 SOUTHVIEW BLVD., SOUTH ST. PAUL, MN 55075
(651) 455-2297
(651) 455-9223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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