Provider Demographics
NPI:1952467615
Name:DENTAL HEALTH CARE CENTER PA
Entity Type:Organization
Organization Name:DENTAL HEALTH CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST CORP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-861-7109
Mailing Address - Street 1:1717 EAST 66TH STREET
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2722
Mailing Address - Country:US
Mailing Address - Phone:612-861-7109
Mailing Address - Fax:612-253-7422
Practice Address - Street 1:1717 EAST 66TH STREET
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2722
Practice Address - Country:US
Practice Address - Phone:612-861-7109
Practice Address - Fax:612-253-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11737122300000X
MND8740122300000X
MND11577122300000X
MND8581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty