Healthcare Provider Details

I. General information

NPI: 1114058336
Provider Name (Legal Business Name): MICHAEL W FUREY DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 VILLAGE CENTER DR SUITE 120
NORTH OAKS MN
55127-3019
US

IV. Provider business mailing address

700 VILLAGE CENTER DR SUITE 120
NORTH OAKS MN
55127-3019
US

V. Phone/Fax

Practice location:
  • Phone: 651-490-9011
  • Fax: 651-490-5081
Mailing address:
  • Phone: 651-490-9011
  • Fax: 651-490-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9131
License Number StateMN

VIII. Authorized Official

Name: DR. MICHAEL WAYNE FUREY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 651-490-9011