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General NPI Number Information
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NPI Number | 1912303777
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Entity Type | Organization
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Legal Business Name | LICENSED DENTAL HYGIENE CARE
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 5201 EDEN AVE SUITE 50
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City | EDINA
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State | MN
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Zip | 55436-2316
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Country | US
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Telephone | 763-545-7545
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Fax | 952-929-2067
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Provider Business Mailing Address
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Address Line | 5201 EDEN AVE SUITE 50
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City | EDINA
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State | MN
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Zip | 55436-2316
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Country | US
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Telephone | 763-545-7545
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Fax | 952-929-2067
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. PATRICIA MICHELLE VACHA
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Credential | R.D.H.
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Telephone | 763-545-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 20071454175
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12696
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License Number State | MN
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