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General NPI Number Information
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NPI Number | 1285726158
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Entity Type | Organization
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Legal Business Name | HEART OF THE CITY DENTAL
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 550 W. BURNSVILLE PKWY SUITE 200
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City | BURNSVILLE
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State | MN
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Zip | 55337
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Country | US
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Telephone | 952-890-2791
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Fax | 952-277-0200
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Provider Business Mailing Address
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Address Line | 550 W. BURNSVILLE PKWY SUITE 200
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City | BURNSVILLE
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State | MN
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Zip | 55337
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Country | US
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Telephone | 952-890-2791
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Fax | 952-277-0200
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TANYA SCHULZ SCHULZ PETERSON
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Credential | DDS
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Telephone | 952-890-2791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7600
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11137
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11806
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License Number State | MN
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