Healthcare Provider Details

I. General information

NPI: 1205228830
Provider Name (Legal Business Name): APPLE TREE DENTAL CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N EL CAMINO REAL
SAN MATEO CA
94401-3710
US

IV. Provider business mailing address

8960 SPRINGBROOK DR NW SITE 150
MINNEAPOLIS MN
55433-5852
US

V. Phone/Fax

Practice location:
  • Phone: 763-600-6896
  • Fax: 763-785-8960
Mailing address:
  • Phone: 763-784-7993
  • Fax: 763-785-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J HELGESON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DDS
Phone: 763-600-6834