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NPI Code Detail

MEDICARE: AMANA DENTAL CORP.

MEDICARE: AMANA DENTAL CORP.
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 DentistryD 11855MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275770596
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMANA DENTAL CORP.
Provider Business Mailing Address
First Line : 2326 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3710
Country : US
Telephone Number : 612-789-2928
Fax Number : 612-789-2783
Provider Business Practice Location Address
First Line : 2326 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3710
Country : US
Telephone Number : 612-789-2928
Fax Number : 612-789-2783
Authorized Official
Title or Position : PRESEDENT
Name : DR. MAZEN MANLA
Credential : DDS
Telephone Number : 312-451-4050
Provider Enumeration Date : 01/08/2009
Last Update Date : 01/08/2009

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