| Community Dental Care Inc | |
|
828 Hawthorne Ave E St. Paul MN 55106 | |
| (651) 774-2959 | |
| (651) 774-1997 |
| Full Name | Community Dental Care Inc |
|---|---|
| Speciality | Dentist |
| Location | 828 Hawthorne Ave E, St. Paul, Minnesota |
| Authorized Official Name and Position | Vacharee Peterson (CEO) |
| Authorized Official Contact | 6519258400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Dental Care Inc 1670 Beam Ave Maplewood MN 55109 Ph: (651) 925-8400 | Community Dental Care Inc 828 Hawthorne Ave E St. Paul MN 55106 Ph: (651) 774-2959 |
| NPI Number | 1003886383 |
|---|---|
| Provider Enumeration Date | 01/26/2006 |
| Last Update Date | 06/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003886383 | NPI | - | NPPES |
| 460668000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 460668000 (Minnesota) | Primary |
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