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General NPI Number Information
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NPI Number | 1396121034
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Entity Type | Organization
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Legal Business Name | JAIN DENTAL PLYMOUTH PLLC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 2050 MERRIMAC LN N STE 201
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City | PLYMOUTH
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State | MN
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Zip | 55447-2186
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Country | US
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Telephone | 763-746-4444
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Fax | 763-473-0816
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Provider Business Mailing Address
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Address Line | 2050 MERRIMAC LN N STE 201
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City | PLYMOUTH
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State | MN
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Zip | 55447-2186
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Country | US
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Telephone | 763-746-4444
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Fax | 763-473-0816
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH PAUL TROWBRIDGE
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Credential | D.D.S.
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Telephone | 651-227-6646
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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 | D12696
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License Number State | MN
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