| O'brien Dental Care | |
|
250 Fuller St S Suite 250 Shakopee MN 55379 | |
| (952) 445-6657 | |
| (952) 445-0674 |
| Full Name | O'brien Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 250 Fuller St S, Shakopee, Minnesota |
| Authorized Official Name and Position | Jodeen J O'brien (OWNER/DENTIST) |
| Authorized Official Contact | 9524456657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| O'brien Dental Care 250 Fuller St S Suite 250 Shakopee MN 55379 Ph: (952) 445-6657 | O'brien Dental Care 250 Fuller St S Suite 250 Shakopee MN 55379 Ph: (952) 445-6657 |
| NPI Number | 1710086459 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 02/15/2019 |
| Medicare PECOS PAC ID | 1850651753 |
|---|---|
| Medicare Enrollment ID | O20180215000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710086459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Jodeen J O'brien |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1538151725 PECOS PAC ID: 7719283274 Enrollment ID: I20180309000329 |
| Provider Name | Miranda J Mulligan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1073961157 PECOS PAC ID: 8729375647 Enrollment ID: I20180327000083 |
| Provider Name | Holly M Mcmahon |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1205129202 PECOS PAC ID: 0648577965 Enrollment ID: I20210507001844 |
| Provider Name | Charles B Wenner |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437721982 PECOS PAC ID: 9537563598 Enrollment ID: I20210812002415 |
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