| Foundations Psa Llc | |
|
126 Pioneer Trl Chaska MN 55318-1167 | |
| (952) 472-7738 | |
| Not Available |
| Full Name | Foundations Psa Llc |
|---|---|
| Speciality | Dentist |
| Location | 126 Pioneer Trl, Chaska, Minnesota |
| Authorized Official Name and Position | Stephanie Miner (OWNER) |
| Authorized Official Contact | 9529554300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundations Psa Llc 1635 Sunnybrook Cir Minnetrista MN 55364-1276 Ph: (612) 387-5009 | Foundations Psa Llc 126 Pioneer Trl Chaska MN 55318-1167 Ph: (952) 472-7738 |
| NPI Number | 1275318628 |
|---|---|
| Provider Enumeration Date | 08/25/2023 |
| Last Update Date | 09/26/2023 |
| Medicare PECOS PAC ID | 7911358213 |
|---|---|
| Medicare Enrollment ID | O20240213001330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275318628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Stephanie Miner |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750470068 PECOS PAC ID: 7517263783 Enrollment ID: I20160315000528 |
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