MEDICARE: TWIN CITIES DENTAL, PA

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376877316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITIES DENTAL, PA

Provider Business Mailing Address
First Line	:	12027 BUSINESS PARK BLVD N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4526
Country	:	US
Telephone Number	:	763-421-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	12027 BUSINESS PARK BLVD N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4526
Country	:	US
Telephone Number	:	763-421-7900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PREM KUMAR
Credential	:	DDS
Telephone Number	:	763-421-7900

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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Directions to “TWIN CITIES DENTAL, PA ” Practice Location

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