| Organization Name: | MENDOTA HEIGHTS DENTAL CENTER |
| NPI Number: | 1730351214 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAM J MAXA (OFFICE MANAGER) |
| Mailing Address: | 880 Sibley Memorial Hwy Mendota Heights |
| State: | MN US |
| Postal Code: | 551181736 |
| Phone Number: | 6514554223 |
| Fax Number: | 6514550107 |
| NPI Enumeration Date: | 03/25/2008 |
| NPI Last Update Date: | 03/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 9102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |