| NPI | 1568071199 |
|---|---|
| Doing Business As | THE DENTAL SPECIALIST DEEPHAVEN |
| Entity Type | Organization |
| Authorized Contact | SHANNON HESSE Credentialing Specialist 651-746-2815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-07-29 |