MEDICARE: READY SET SMILE PA

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	1223D0001X	Public Health Dentistry	D9933	MN
2	1223D0001X	Public Health Dentistry	D9919	MN
3	125J00000X	Dental Therapist	DT3	MN

General Provider Information

NPI Number	:	1679911531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	READY SET SMILE PA

Provider Business Mailing Address
First Line	:	3501 ALDRICH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408
Country	:	US
Telephone Number	:	612-377-6108
Fax Number	:	612-374-1820

Provider Business Practice Location Address
First Line	:	3501 ALDRICH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408
Country	:	US
Telephone Number	:	612-721-6118
Fax Number	:	612-722-0723

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TESSA WETJEN
Credential	:
Telephone Number	:	612-721-6118

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	03/10/2026

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Directions to “READY SET SMILE PA ” Practice Location

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