Provider Demographics
NPI:1104193762
Name:MINNEAPOLIS-ST.PAUL ENDODONTICS
Entity Type:Organization
Organization Name:MINNEAPOLIS-ST.PAUL ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-439-2600
Mailing Address - Street 1:10150 CITY WALK DR STE C
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129
Mailing Address - Country:US
Mailing Address - Phone:651-714-7111
Mailing Address - Fax:651-714-9005
Practice Address - Street 1:10150 CITY WALK DR STE C
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129
Practice Address - Country:US
Practice Address - Phone:651-714-7111
Practice Address - Fax:651-714-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty