MEDICARE: DOORSTEP HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	734432000	MN

General Provider Information

NPI Number	:	1033307046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOORSTEP HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	5861 CEDAR LAKE RD S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	763-541-6000
Fax Number	:	763-277-5227

Provider Business Practice Location Address
First Line	:	5861 CEDAR LAKE RD S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	763-541-6000
Fax Number	:	763-277-5227

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LYNNE MADER
Credential	:
Telephone Number	:	763-541-6000

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	06/16/2008

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Directions to “DOORSTEP HEALTHCARE SERVICES ” Practice Location

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