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General NPI Number Information
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NPI Number | 1811061054
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Entity Type | Organization
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Legal Business Name | DAKOTA CHILDREN'S DENTISTRY
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5955 CARMEN AVE
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-4416
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Country | US
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Telephone | 651-450-6111
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Fax | 651-450-0668
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Provider Business Mailing Address
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Address Line | 5955 CARMEN AVE
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-4416
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Country | US
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Telephone | 651-450-6111
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Fax | 651-450-0668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL H GLENN
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Credential | D.D.S, M.S.
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Telephone | 651-322-5788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D10462
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License Number State | MN
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