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General NPI Number Information
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NPI Number | 1770540502
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Entity Type | Organization
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Legal Business Name | TWIN CITIES ENDODONTIC SPECIALISTS, P.A.
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 2550 UNIVERSITY AVE W SUITE 155S
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City | SAINT PAUL
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State | MN
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Zip | 55114-1052
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Country | US
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Telephone | 651-646-6386
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Fax | 651-649-3074
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Provider Business Mailing Address
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Address Line | 2550 UNIVERSITY AVE W SUITE 155S
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City | SAINT PAUL
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State | MN
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Zip | 55114-1052
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Country | US
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Telephone | 651-646-6386
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Fax | 651-649-3074
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. DEB WELTERS
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Credential | L.D.A.
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Telephone | 651-646-6386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | MN
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