MEDICARE: DENTAL HEALTH CARE CENTER 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	122300000X	Dentist	D11737	MN
2	122300000X	Dentist	D8740	MN
3	122300000X	Dentist	D8581	MN
4	122300000X	Dentist	D11577	MN

General Provider Information

NPI Number	:	1952467615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH CARE CENTER PA

Provider Business Mailing Address
First Line	:	1717 EAST 66TH STREET
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2722
Country	:	US
Telephone Number	:	612-861-7109
Fax Number	:	612-253-7422

Provider Business Practice Location Address
First Line	:	1717 EAST 66TH STREET
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2722
Country	:	US
Telephone Number	:	612-861-7109
Fax Number	:	612-253-7422

Authorized Official
Title or Position	:	GENERAL DENTIST CORP PRESIDENT
Name	:	DR. JOHN MICHAEL WOELL
Credential	:	DDS
Telephone Number	:	612-861-7109

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	09/24/2014

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Directions to “DENTAL HEALTH CARE CENTER PA ” Practice Location

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