Healthcare Provider Details

I. General information

NPI: 1750226643
Provider Name (Legal Business Name): BENJAMIN ALEXANDER MENNELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13173 60TH ST N
STILLWATER MN
55082-1056
US

IV. Provider business mailing address

138 DAHLIA ST
MAHTOMEDI MN
55115-1613
US

V. Phone/Fax

Practice location:
  • Phone: 651-247-7999
  • Fax:
Mailing address:
  • Phone: 651-247-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15519
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: