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General NPI Number Information
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NPI Number | 1336430149
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Entity Type | Organization
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Legal Business Name | GROUP HEALTH PLAN, INC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 2150 THIRD AVENUE SUITE 200
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City | ANOKA
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State | MN
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Zip | 55303-2206
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Country | US
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Telephone | 763-421-9292
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Fax | 763-421-7559
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Provider Business Mailing Address
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Address Line | 2150 THIRD AVENUE SUITE 200
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City | ANOKA
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State | MN
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Zip | 55303-2206
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Country | US
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Telephone | 763-421-9292
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Fax | 763-421-7559
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Authorized Official
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Title or Position | SR. VP/DENTAL DIR.
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Name | DR. DAVID S GESKO
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Credential | DDS
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Telephone | 952-883-7577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D12245
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License Number State | MN
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