MEDICARE: WEST END DENTAL PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1396690863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST END DENTAL PLLC

Provider Business Mailing Address
First Line	:	1660 HIGHWAY 100 S STE 122
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-1483
Country	:	US
Telephone Number	:	952-544-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 HIGHWAY 100 S STE 122
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-1483
Country	:	US
Telephone Number	:	952-544-4129
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MERISSA VELMA RICHTER MARCUSSEN
Credential	:	DDS
Telephone Number	:	612-247-2314

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “WEST END DENTAL PLLC ” Practice Location

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