| 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 |