Healthcare Provider Details

I. General information

NPI: 1679620801
Provider Name (Legal Business Name): AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MINNETONKA MILLS RD
MINNETONKA MN
55305-5161
US

IV. Provider business mailing address

11601 MINNETONKA MILLS RD
MINNETONKA MN
55305-5161
US

V. Phone/Fax

Practice location:
  • Phone: 952-935-8420
  • Fax: 952-935-0147
Mailing address:
  • Phone: 952-935-8420
  • Fax: 952-935-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES CARL BLOCK
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 952-935-8420