Provider Demographics
NPI:1457448615
Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Other - Org Name:UNIVERSITY OF MINNESOTA SCHOOL OF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN, UOFMN SCHOOL OF DENTISTRY
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-626-6529
Mailing Address - Street 1:515 DELAWARE ST SE
Mailing Address - Street 2:7-530 MOOS TOWER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0357
Mailing Address - Country:US
Mailing Address - Phone:612-626-6529
Mailing Address - Fax:612-625-4610
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:7-530 MOOS TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-626-6529
Practice Address - Fax:612-625-4610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN107553500Medicaid
MNC00454Medicare PIN