Provider Demographics
NPI:1245416403
Name:SNELLING AVENUE DENTAL
Entity type:Organization
Organization Name:SNELLING AVENUE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-699-5600
Mailing Address - Street 1:604 SNELLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1528
Mailing Address - Country:US
Mailing Address - Phone:651-699-5600
Mailing Address - Fax:651-699-1966
Practice Address - Street 1:604 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1528
Practice Address - Country:US
Practice Address - Phone:651-699-5600
Practice Address - Fax:651-699-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty