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General NPI Number Information
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NPI Number | 1801068358
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Entity Type | Organization
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Legal Business Name | AL M VIRGEN DMD PA
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 7501 80TH ST S SUITE 2
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3020
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Country | US
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Telephone | 651-459-7888
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Fax | 651-459-7614
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Provider Business Mailing Address
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Address Line | 7501 80TH ST S SUITE 2
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3020
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Country | US
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Telephone | 651-459-7888
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Fax | 651-459-7614
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Authorized Official
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Title or Position | CEO
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Name | DR. AL M VIRGEN
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Credential | DMD
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Telephone | 651-459-7888
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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 | D12872
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License Number State | MN
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