123 Brush Dental LLC
Organization Active NPI Dental Clinic/Center · Maplewood, MN
NPI 1053807016 · NPPES record last updated Jul 2, 2018
Key facts
- NPI
- 1053807016
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- D9309 (MN)
- Legal business name
- 123 BRUSH DENTAL LLC
- Practice address
- 1670 Beam Ave
Ste 202
Maplewood, MN 55109 - Phone
- (651) 779-4195
- NPI assigned
- Jul 2, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Vacharee Sriswad Peterson, DDS
- Title
- Dentist
- Phone
- (651) 779-4195
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | D9309 | MN | Yes |
Addresses
Primary practice location
1670 Beam Ave
Ste 202
Maplewood, MN 55109
Mailing address
1670 Beam Ave
Ste 202
Maplewood, MN 55109
Phone (651) 779-4195
Other providers in Maplewood, MN
- 5 Star Adult Day Center Inc
- A-Ride Transportation
- Aa Recovery Home Care Inc
- Adrienne Jo Aasand
- Hirie Muhe Abbajebel
All providers in Maplewood, MN · Dental Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.