| Distinctive Dental Services Pa | |
| 
					4716 Central Ave Ne Hilltop MN 55421-1944  | |
| (763) 572-9762 | |
| (763) 572-2827 | 
| Full Name | Distinctive Dental Services Pa | 
|---|---|
| Speciality | Dentist - General Practice | 
| Location | 4716 Central Ave Ne, Hilltop, Minnesota | 
| Authorized Official Name and Position | Michael John Thoennes (CEO) | 
| Authorized Official Contact | 7635729762 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Distinctive Dental Services Pa 4716 Central Ave Ne Hilltop MN 55421-1944 Ph: (763) 572-9762  | Distinctive Dental Services Pa 4716 Central Ave Ne Hilltop MN 55421-1944 Ph: (763) 572-9762  | 
| NPI Number | 1144484205 | 
|---|---|
| Provider Enumeration Date | 07/17/2008 | 
| Last Update Date | 07/17/2008 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1144484205 | NPI | - | NPPES | 
| 949522300 | Medicaid | MN | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D08971 (Minnesota) | Primary |