| Central Mn Pediatric Dentists Pa | |
|
1900 Centracare Circle Ste 0350 St Cloud MN 56303-5000 | |
| (320) 253-0272 | |
| (320) 251-2661 |
| Full Name | Central Mn Pediatric Dentists Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1900 Centracare Circle, St Cloud, Minnesota |
| Authorized Official Name and Position | Joseph Hall Wenner (PRESIDENT) |
| Authorized Official Contact | 3202530272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Mn Pediatric Dentists Pa 1900 Centracare Circle Ste 0350 St Cloud MN 56303-5000 Ph: (320) 253-0272 | Central Mn Pediatric Dentists Pa 1900 Centracare Circle Ste 0350 St Cloud MN 56303-5000 Ph: (320) 253-0272 |
| NPI Number | 1144267063 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 06/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144267063 | NPI | - | NPPES |
| 678350300 | Medicaid | MN | |
| 55520WE | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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