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General NPI Number Information
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NPI Number | 1578606778
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALISTS OF MINNESOTA, PLLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 6437 BROOKLYN BLVD
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2174
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Country | US
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Telephone | 952-926-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 COUNTY ROAD C W SUITE 2210
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City | ROSEVILLE
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State | MN
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Zip | 55113-2550
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Country | US
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Telephone | 651-633-0500
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Fax | 651-636-6350
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN LAW
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Credential | D.D.S.,PHD
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Telephone | 651-633-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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