Healthcare Provider Details

I. General information

NPI: 1972699056
Provider Name (Legal Business Name): THOMAS MATTHEW DRESEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RADIO DR STE 110
WOODBURY MN
55125-8445
US

IV. Provider business mailing address

1000 RADIO DR STE 110
WOODBURY MN
55125-8445
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-1585
  • Fax: 651-735-1287
Mailing address:
  • Phone: 651-735-1585
  • Fax: 651-735-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD10827
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: