Healthcare Provider Details

I. General information

NPI: 1538963590
Provider Name (Legal Business Name): CLEARCHOICE DENTAL IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 CLEVELAND AVE N
ARDEN HILLS MN
55112-3505
US

IV. Provider business mailing address

3130 CLEVELAND AVE N
ARDEN HILLS MN
55112-3505
US

V. Phone/Fax

Practice location:
  • Phone: 763-515-4000
  • Fax: 763-515-4008
Mailing address:
  • Phone: 763-515-4000
  • Fax: 763-515-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASANDRA JOHNSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 763-515-4000