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General NPI Number Information
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NPI Number | 1457411753
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Entity Type | Organization
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Legal Business Name | JEROME E. EUTENEUER DDS PA
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Dates
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Enumeration Date | 12/10/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S SUITE 270
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-927-7744
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Fax | 952-927-5767
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Provider Business Mailing Address
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Address Line | 6545 FRANCE AVE S SUITE 270
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-927-7744
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Fax | 952-927-5767
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROME E. EUTENEUER
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Credential | DDS
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Telephone | 952-927-7744
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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 | 8767
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License Number State | MN
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