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General NPI Number Information
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NPI Number | 1821228347
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Entity Type | Organization
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Legal Business Name | SMILES ON SEVENTH, LTD.
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 2390 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2800
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Country | US
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Telephone | 651-699-1234
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Fax | 651-699-7715
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Provider Business Mailing Address
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Address Line | 2390 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2800
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Country | US
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Telephone | 651-699-1234
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Fax | 651-699-7715
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANN ELIZABETH JENNEN
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Credential | D.D.S.
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Telephone | 651-699-1234
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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 | D11243
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License Number State | MN
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