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General NPI Number Information
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NPI Number | 1194826917
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Entity Type | Organization
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Legal Business Name | METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 2855 CAMPUS DR STE 670
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City | PLYMOUTH
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State | MN
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Zip | 55441-2649
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Country | US
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Telephone | 763-520-1234
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Fax | 763-520-1233
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Provider Business Mailing Address
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Address Line | 2855 CAMPUS DR STE 670
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City | PLYMOUTH
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State | MN
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Zip | 55441-2649
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Country | US
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Telephone | 763-520-1234
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Fax | 763-520-1233
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. MICHELE ANN HORNER
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Credential |
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Telephone | 763-257-0530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9698
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License Number State | MN
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