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General NPI Number Information
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NPI Number | 1427604214
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Entity Type | Organization
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Legal Business Name | A GENTLE DENTAL CENTER OF ROBBINSDALE
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 4930 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1731
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Country | US
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Telephone | 763-537-4531
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Fax |
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Provider Business Mailing Address
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Address Line | 4930 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1731
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Country | US
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Telephone | 763-537-4531
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGING MEMBER
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Name | DR. JILL PUCEL KOOPMAN
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Credential | D.D.S.
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Telephone | 763-537-4531
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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 |
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License Number State |
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