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General NPI Number Information
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NPI Number | 1992890917
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY & COSMETIC INSTITUTE P.A.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6525 BARRIE RD
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City | EDINA
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State | MN
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Zip | 55435-2305
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Country | US
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Telephone | 952-915-6000
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Fax | 952-915-6100
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Provider Business Mailing Address
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Address Line | 6525 BARRIE RD
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City | EDINA
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State | MN
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Zip | 55435-2305
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Country | US
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Telephone | 952-915-6000
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Fax | 952-915-6100
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. MARIE ELIZABETH BRIDEN
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Credential | MD
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Telephone | 952-915-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MN28680
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License Number State | MN
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