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General NPI Number Information
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NPI Number | 1417932773
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Entity Type | Individual
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Provider Name | HOSSEIN A JALALI D.D.S
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 991 9TH AVE NW
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-2665
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Country | US
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Telephone | 651-633-1311
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Fax | 651-633-4339
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Provider Business Mailing Address
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Address Line | 991 9TH AVE NW
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-2665
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Country | US
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Telephone | 651-633-1311
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Fax | 651-633-4339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10256
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License Number State | MN
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