| Mahtomedi Dental Clinic | |
|
814 Mahtomedi Ave Mahtomedi MN 55115-1730 | |
| (651) 426-0011 | |
| (651) 426-2075 |
| Full Name | Mahtomedi Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 814 Mahtomedi Ave, Mahtomedi, Minnesota |
| Authorized Official Name and Position | Timothy A Bray (OWNER / DENTIST) |
| Authorized Official Contact | 6514260011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahtomedi Dental Clinic 814 Mahtomedi Ave Mahtomedi MN 55115-1730 Ph: (651) 426-0011 | Mahtomedi Dental Clinic 814 Mahtomedi Ave Mahtomedi MN 55115-1730 Ph: (651) 426-0011 |
| NPI Number | 1326284597 |
|---|---|
| Provider Enumeration Date | 12/18/2008 |
| Last Update Date | 12/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326284597 | NPI | - | NPPES |
| 982017500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8217 (Minnesota) | Primary |
Mahtomedi Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 814 Mahtomedi Ave, Mahtomedi, MN 55115 Phone: 651-426-0011 | |
Mahtomedi Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 814 Mahtomedi Ave, Mahtomedi Dental, Mahtomedi, MN 55115 Phone: 651-426-0011 Fax: 651-426-2075 | |
Orchard Dental Group, P.l.l.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12 Long Lake Rd # 12, Mahtomedi, MN 55115 Phone: 651-770-2699 Fax: 651-770-9896 |