Provider Demographics
NPI:1710854369
Name:MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Entity type:Organization
Organization Name:MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:REID
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-577-2484
Mailing Address - Street 1:3475 PLYMOUTH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1539
Mailing Address - Country:US
Mailing Address - Phone:763-577-2484
Mailing Address - Fax:763-577-1375
Practice Address - Street 1:3100 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9600
Practice Address - Country:US
Practice Address - Phone:763-577-2484
Practice Address - Fax:763-577-1375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty