GRAND AVENUE DENTAL, LLC
NPI 1154933661
Clinic/Center - Dental in Saint Paul, MN
Active since August 18, 2020
About Grand Avenue Dental, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRAND AVENUE DENTAL, LLC (NPI 1154933661) is a healthcare organization registered as a dental in Saint Paul, Minnesota and active in the NPI registry since August 2020. The organization lists Robert S Tyler, Business Manager, as its authorized official.
NPPES Registry Identity
NPI1154933661
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameGRAND AVENUE DENTAL, LLC
Location Address960 GRAND AVESaint Paul, MN 55105-3014
Mailing Address960 Grand AveSaint Paul, MN 55105-3014 · (651) 291-9667
Phone(651) 291-9667
Organization SubpartNo
Authorized OfficialRobert S TylerBusiness Manager · (651) 291-9667
Enumeration DateAugust 18, 2020
NPPES CertifiedAugust 18, 2020
✔ NPI 1154933661 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
960 GRAND AVE, Saint Paul, MN 55105
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154933661, enumerated as an "organization" on August 18, 2020.
The provider is located at 960 GRAND AVE SAINT PAUL, MN 55105 and the phone number is (651) 291-9667.
Clinic/Center with taxonomy code 261QD0000X and a focus in Dental.
