Healthcare Provider Details

I. General information

NPI: 1255369278
Provider Name (Legal Business Name): CAMEO DENTAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14470 CAMEO AVE
ROSEMOUNT MN
55068-4025
US

IV. Provider business mailing address

PO BOX 170
ROSEMOUNT MN
55068-0170
US

V. Phone/Fax

Practice location:
  • Phone: 651-423-2259
  • Fax:
Mailing address:
  • Phone: 651-423-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMN

VIII. Authorized Official

Name: MARY SWEDIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 651-423-2259