Provider Demographics
NPI:1225201213
Name:TWIN CITIES TMJ & FACIAL PAIN CLINIC, LTD.
Entity Type:Organization
Organization Name:TWIN CITIES TMJ & FACIAL PAIN CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STREIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-931-9961
Mailing Address - Street 1:6600 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 191
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4744
Mailing Address - Country:US
Mailing Address - Phone:952-931-9961
Mailing Address - Fax:952-931-3944
Practice Address - Street 1:6600 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 191
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4744
Practice Address - Country:US
Practice Address - Phone:952-931-9961
Practice Address - Fax:952-931-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01705Medicare PIN