MEDICARE: VADNAIS HEIGHTS FAMILY DENTISTRY, P.A.

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	261QD0000X	Dental Clinic/Center	D10099	MN

General Provider Information

NPI Number	:	1366772758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VADNAIS HEIGHTS FAMILY DENTISTRY, P.A.

Provider Business Mailing Address
First Line	:	1230 COUNTY ROAD E E
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5132
Country	:	US
Telephone Number	:	651-482-0180
Fax Number	:	651-482-7957

Provider Business Practice Location Address
First Line	:	1230 COUNTY ROAD E E
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5132
Country	:	US
Telephone Number	:	651-482-0180
Fax Number	:	651-482-7957

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES C. ANDREA
Credential	:	DDS
Telephone Number	:	651-482-0180

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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