| Champlin Family Dental Pa | |
|
12233 Champlin Drive Champlin MN 55316 | |
| (763) 323-0678 | |
| (763) 323-9102 |
| Full Name | Champlin Family Dental Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12233 Champlin Drive, Champlin, Minnesota |
| Authorized Official Name and Position | Krista Susan Bauer (DENTIST) |
| Authorized Official Contact | 7633230678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Champlin Family Dental Pa 12233 Champlin Drive Champlin MN 55316 Ph: (763) 323-0678 | Champlin Family Dental Pa 12233 Champlin Drive Champlin MN 55316 Ph: (763) 323-0678 |
| NPI Number | 1992818751 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 04/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992818751 | NPI | - | NPPES |
| 624020800 | Other | MN | MEDICAL ASSISTANCE TAX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 9624 (Minnesota) | Primary |
| 1223G0001X | Dentist - General Practice | 11195 (Minnesota) | Secondary |
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