Healthcare Provider Details

I. General information

NPI: 1700980455
Provider Name (Legal Business Name): GESICA TENEL HORN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VILLAGE CENTER DRIVE SUITE 100
NORTH OAKS MN
55127-7203
US

IV. Provider business mailing address

400 VILLAGE CENTER DRIVE SUITE 100
NORTH OAKES MN
55512-7203
US

V. Phone/Fax

Practice location:
  • Phone: 651-288-3111
  • Fax: 651-288-3113
Mailing address:
  • Phone: 651-288-3111
  • Fax: 651-288-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11597
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: