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NPI Code Detail

MEDICARE: BLUE RIDGE DENTAL CENTER PA

MEDICARE: BLUE RIDGE DENTAL 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
11223G0001XGeneral Practice DentistryD11518MN

General Provider Information

NPI Number : 1952468654
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE DENTAL CENTER PA
Provider Business Mailing Address
First Line : 11601 MINNETONKA MILLS RD
Second Line : SUITE D
City : MINNETONKA
State : MN
Zip : 55305-5161
Country : US
Telephone Number : 952-938-8858
Fax Number :
Provider Business Practice Location Address
First Line : 11601 MINNETONKA MILLS RD
Second Line : SUITE D
City : MINNETONKA
State : MN
Zip : 55305-5161
Country : US
Telephone Number : 952-938-8858
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : DR. JUSTIN J MCHUGH
Credential : DDS
Telephone Number : 952-938-8858
Provider Enumeration Date : 01/02/2007
Last Update Date : 08/22/2020

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Directions to “BLUE RIDGE DENTAL CENTER PA ” Practice Location

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