MEDICARE: FACIAL PAIN CENTER 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
1	122300000X	Dentist
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1407325830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACIAL PAIN CENTER PLLC

Provider Business Mailing Address
First Line	:	2200 COUNTY ROAD C W STE 2210
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2551
Country	:	US
Telephone Number	:	651-746-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 COUNTY ROAD C W STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1353
Country	:	US
Telephone Number	:	651-636-2016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHRISTOPHER STEELE
Credential	:	DDS
Telephone Number	:	651-746-2815

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	10/30/2020

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Directions to “FACIAL PAIN CENTER PLLC ” Practice Location

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