| Plaza Dental Pa | |
|
1601 E Hwy 13 Suite 105 Burnsville MN 55337 | |
| (952) 890-5450 | |
| (952) 707-1122 |
| Full Name | Plaza Dental Pa |
|---|---|
| Speciality | Dentist |
| Location | 1601 E Hwy 13, Burnsville, Minnesota |
| Authorized Official Name and Position | Joan A Sheppard (OWNER OFFICER) |
| Authorized Official Contact | 9528905450 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Plaza Dental Pa 1601 E Hwy 13 Suite 105 Burnsville MN 55337 Ph: (952) 890-5450 | Plaza Dental Pa 1601 E Hwy 13 Suite 105 Burnsville MN 55337 Ph: (952) 890-5450 |
| NPI Number | 1316976517 |
|---|---|
| Provider Enumeration Date | 07/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316976517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D7323 (Minnesota) | Secondary |
| 122300000X | Dentist | D8868 (Minnesota) | Primary |
| 122300000X | Dentist | D11218 (Minnesota) | Secondary |
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