Provider Demographics
NPI:1720329535
Name:MINNESOTA DENTAL CENTER
Entity Type:Organization
Organization Name:MINNESOTA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-208-9389
Mailing Address - Street 1:17601 HIGHWAY 7
Mailing Address - Street 2:#200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4104
Mailing Address - Country:US
Mailing Address - Phone:651-738-1880
Mailing Address - Fax:
Practice Address - Street 1:17601 HIGHWAY 7
Practice Address - Street 2:#200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4104
Practice Address - Country:US
Practice Address - Phone:651-738-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013036995OtherINDIVIDUAL NPI