Healthcare Provider Details

I. General information

NPI: 1457448615
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/24/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELAWARE ST SE 7-530 MOOS TOWER
MINNEAPOLIS MN
55455-0357
US

IV. Provider business mailing address

515 DELAWARE ST SE 7-220 MOOS TOWER
MINNEAPOLIS MN
55455-0357
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-6529
  • Fax: 612-625-4610
Mailing address:
  • Phone: 612-624-2424
  • Fax: 612-625-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH MAYS
Title or Position: DEAN, UOFMN SCHOOL OF DENTISTRY
Credential: DDS, MS, PHD
Phone: 612-624-2424