| North St. Paul Dental | |
|
2082 11th Ave E North St Paul MN 55109-5112 | |
| (651) 770-6260 | |
| Not Available |
| Full Name | North St. Paul Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2082 11th Ave E, North St Paul, Minnesota |
| Authorized Official Name and Position | Timothy A Bray (OWNER/ DENTIST) |
| Authorized Official Contact | 6517706260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North St. Paul Dental 814 Mahtomedi Ave Mahtomedi MN 55115-1730 Ph: (651) 426-0011 | North St. Paul Dental 2082 11th Ave E North St Paul MN 55109-5112 Ph: (651) 770-6260 |
| NPI Number | 1497991798 |
|---|---|
| Provider Enumeration Date | 12/17/2008 |
| Last Update Date | 12/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497991798 | NPI | - | NPPES |
| 982017500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8217 (Minnesota) | Primary |
James G Koller Dds,pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2601 Centennial Dr Ste 102, North St Paul, MN 55109 Phone: 651-777-6454 Fax: 651-773-9206 |