MEDICARE: MAHTOMEDI FAMILY DENTAL

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	D7721	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1720415896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHTOMEDI FAMILY DENTAL

Provider Business Mailing Address
First Line	:	814 MAHTOMEDI AVE
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 MAHTOMEDI AVE
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-1730
Country	:	US
Telephone Number	:	651-426-0011
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BRIAN WELLE
Credential	:
Telephone Number	:	651-426-0011

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	10/03/2013

Similar Medicare Providers

1265520274 — STEVEN HAGSTROM D.C.
Practice Location Address:

814 MAHTOMEDI AVE
MAHTOMEDI, MN
55115-1730

Practice Phone: 651-426-2210
Practice Fax: 651-426-2210

1841462652 — MAHTOMEDI DENTAL CLINIC
Practice Location Address:

814 MAHTOMEDI AVE , MAHTOMEDI DENTAL
MAHTOMEDI, MN
55115-1730

Practice Phone: 651-426-0011
Practice Fax: 651-426-2075

1326284597 — MAHTOMEDI DENTAL CLINIC
Practice Location Address:

814 MAHTOMEDI AVE
MAHTOMEDI, MN
55115-1730

Practice Phone: 651-426-0011
Practice Fax: 651-426-2075

1316426752 — BRADLEY JOHN HAGEN
Practice Location Address:

814 MAHTOMEDI AVE
MAHTOMEDI, MN
55115-1730

Practice Phone: 651-426-0011
Practice Fax:

1497743454 — AM SCHNEIDER PA
Practice Location Address:

357 QUAIL ST
MAHTOMEDI, MN
55115-1455

Practice Phone: 612-221-8189
Practice Fax: 651-698-6232

1730125063 — DR. RICHARD WINFIELD COPELAND JR. DDS
Practice Location Address:

130 HICKORY ST
MAHTOMEDI, MN
55115

Practice Phone: 651-426-9720
Practice Fax:

Directions to “MAHTOMEDI FAMILY DENTAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.