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Contact Information

MINNEAPOLIS-ST. PAUL PERIODONTICS
1109 EAST MOORE LAKE DRIVE
FRIDLEY, MN55432
 Phone: 651-439-2600
 Fax: 651-439-2211
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Periodontics

1223P0300X
Indicates primary specialty

NPI Profile & details for MINNEAPOLIS-ST. PAUL PERIODONTICS

NPI Number 1013216811
LBN Legal business name MINNEAPOLIS-ST. PAUL PERIODONTICS
Authorized official DOUG WOLFF - (OWNER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/18/2011
Last updated 03/18/2011 - About 15 years ago
Identifiers
MN License # D11710
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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