Organization Name: | MINNESOTA CRANIOFACIAL CENTER P.C. |
NPI Number: | 1104160480 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM MARIE LEDERMANN (DENTIST/OWNER) |
Mailing Address: | 2550 University Ave W Suite 143n Saint Paul |
State: | MN US |
Postal Code: | 551141052 |
Phone Number: | 6516421013 |
Fax Number: | 6516420947 |
NPI Enumeration Date: | 11/26/2012 |
NPI Last Update Date: | 06/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | 11715 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |