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General NPI Number Information
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NPI Number | 1346393485
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Entity Type | Organization
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Legal Business Name | PATRICK J ENNEN DDS PA
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Dates
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Enumeration Date | 01/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3960 COON RAPIDS BLVD NW 213
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City | COON RAPIDS
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State | MN
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Zip | 55433-2569
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Country | US
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Telephone | 763-427-4912
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Fax |
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Provider Business Mailing Address
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Address Line | 3960 COON RAPIDS BLVD NW 213
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City | COON RAPIDS
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State | MN
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Zip | 55433-2569
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Country | US
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Telephone | 763-427-4912
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK JOSEPH ENNEN
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Credential | DDS
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Telephone | 763-427-4912
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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 | 7668
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License Number State | MN
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