Provider Demographics
NPI:1225095052
Name:TWIN CITIES ENDODONTIC SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:TWIN CITIES ENDODONTIC SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:651-994-1344
Mailing Address - Street 1:4640 NICOLS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2306
Mailing Address - Country:US
Mailing Address - Phone:651-994-1344
Mailing Address - Fax:651-994-1343
Practice Address - Street 1:4640 NICOLS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2306
Practice Address - Country:US
Practice Address - Phone:651-994-1344
Practice Address - Fax:651-994-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty