Distinctive Dental Services PA
Organization Active NPI General Practice Dentistry · Hilltop, MN
NPI 1144484205 · NPPES record last updated Jul 17, 2008
Key facts
- NPI
- 1144484205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D08971 (MN)
- Legal business name
- DISTINCTIVE DENTAL SERVICES PA
- Practice address
- 4716 Central Ave NE
Hilltop, MN 55421-1944 - Phone
- (763) 572-9762
- Fax
- (763) 572-2827
- NPI assigned
- Jul 17, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- DISTINCTIVE DENTAL SERVICES, PA
Authorized official
- Name
- Dr. Michael John Thoennes, DDS
- Title
- Ceo
- Phone
- (763) 572-9762
Parent organization (reported in NPPES) 1
Corporate family (same tax ID) 2
Practitioners 1
-
John Moyer Poage, D.D.S.
National Provider Directory
- Tax ID family
- Distinctive Dental Services PA
- Part of
- Distinctive Dental Services PA
Locations
4716 Central Ave NE
Hilltop, MN 55421
Phone (763) 572-9762
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | D08971 | MN | Yes |
Addresses
Primary practice location
4716 Central Ave NE
Hilltop, MN 55421-1944
Mailing address
4716 Central Ave NE
Hilltop, MN 55421-1944
Phone (763) 572-9762
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 949522300 | Medicaid | MN |
Other names
- Hilltop Dental
Other providers in Hilltop, MN
- Ryan Joseph Bernhardt
- Jennifer Brooks
- Seyoon Chung
- Tewodros Gemeda
- Steven Wayne Holloway
- Alida Jacob
- Alexys McGauvran
- Medexpress Urgent Care Minnesota P.C.
All providers in Hilltop, MN · General Practice Dentistry 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 17, 2008. 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.