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General NPI Number Information
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NPI Number | 1568546992
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF MINNESOTA
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 1515 E 25TH ST ROOM C-153
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City | HIBBING
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State | MN
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Zip | 55746-3354
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Country | US
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Telephone | 218-263-2917
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Fax | 218-263-2971
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Provider Business Mailing Address
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Address Line | 1515 E 25TH ST ROOM C-153
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City | HIBBING
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State | MN
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Zip | 55746-3354
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Country | US
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Telephone | 218-263-2917
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Fax | 218-263-2971
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Authorized Official
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Title or Position | DEAN
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Name | GARY CARL ANDERSON
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Credential | DDS
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Telephone | 612-626-6529
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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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