Nicollet Dental

NPI 1003108895 - Dentist - 122300000X

NPI Details
NPI 1003108895
Enumeration Date 05/11/2011
Last Updated 05/11/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name CASEY LEE CASEY
Position OWNER
Phone (612) 866-8550
Fax (612) 866-9453
Practice Location
6101 NICOLLET AVE. SO.
MINNEAPOLIS MN, 55419, US
Phone (612) 866-8550
Fax (612) 866-9453
Business Location
6101 NICOLLET AVE. SO.
MINNEAPOLIS MN, 55419, US
Phone (612) 866-8550
Fax (612) 866-9453
Toxanomy
Taxonomy Code 122300000X
License State Minnesota
License Number D12104
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According to our database, Nicollet Dental NPI is 1003108895, taxonomy code is 122300000X and license number is D12104, license state is located at Minnesota. Nicollet Dental physically located at 6101 Nicollet Ave. So., Minneapolis MN, 55419. NPI Number 1033115704 has the healthcare provider type.

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1003108895 NPI number is provided on an as is basis without warranty of any kind. 1003108895 is maintained by the National Plan & Provider Enumeration System. The contents of Nicollet Dental are for informational purposes only.