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General NPI Number Information
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NPI Number | 1427156249
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Entity Type | Organization
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Legal Business Name | OCEANVIEW MANAGEMENT INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 15910 46TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55446
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Country | US
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Telephone | 763-218-5350
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Fax | 763-561-5761
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Provider Business Mailing Address
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Address Line | 15910 46TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55446
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Country | US
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Telephone | 763-218-5350
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Fax | 763-561-5761
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID E DOMAAS
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Credential |
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Telephone | 763-218-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9409
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License Number State | MN
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