Organization Name: | ADVANCE FAMILY DENTAL |
NPI Number: | 1053591255 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOLLY SEIDL (OFFICE MANAGER) |
Mailing Address: | 925 County Road E E Suite 185 Vadnais Heights |
State: | MN US |
Postal Code: | 551277179 |
Phone Number: | 6514821122 |
Fax Number: | 6517662557 |
NPI Enumeration Date: | 11/06/2007 |
NPI Last Update Date: | 11/06/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 12387 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |