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NPI Code Detail

MEDICARE: INSIDE EDGE DENTAL PLLC

MEDICARE: INSIDE EDGE DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1114360492
Entity Type Code : Organization
Provider Name (Legal Business Name) : INSIDE EDGE DENTAL PLLC
Provider Business Mailing Address
First Line : 1346 PAYNE AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55130-3434
Country : US
Telephone Number : 651-774-6085
Fax Number : 651-774-2660
Provider Business Practice Location Address
First Line : 1346 PAYNE AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55130-3434
Country : US
Telephone Number : 651-774-6085
Fax Number : 651-774-2660
Authorized Official
Title or Position : DDS/PRESIDENT
Name : JENNIFER A MARKER JOHNSON
Credential : DDS
Telephone Number : 651-774-6085
Provider Enumeration Date : 04/16/2013
Last Update Date : 02/02/2017

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Directions to “INSIDE EDGE DENTAL PLLC ” Practice Location

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