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General NPI Number Information
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NPI Number | 1023872835
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Entity Type | Organization
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Legal Business Name | ABBA HEALTHCARE PLLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 6936 PINE ARBOR DR S STE 230
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4645
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Country | US
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Telephone | 651-204-5257
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Fax |
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Provider Business Mailing Address
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Address Line | 2052 IRENE ST
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City | ROSEVILLE
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State | MN
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Zip | 55113-6613
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Country | US
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Telephone | 712-309-6588
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. EBOSETALE OKORUWA
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Credential | DDS
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Telephone | 712-309-6588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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