Mahtomedi Dental Clinic

NPI #1326284597 in Mahtomedi, Minnesota

Provider Information

NPI Number: 1326284597
Entity Type: Organization
Organization Name: Mahtomedi Dental Clinic
Subpart: Yes (part of a larger organization)
Parent Organization: MAHTOMEDI DENTAL CLINIC
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 18, 2008
Last Updated: Dec 18, 2008

Practice Location

Address: 814 MAHTOMEDI AVE
City: Mahtomedi
State: Minnesota
ZIP Code: 55115-1730
Phone: (651) 426-0011

Authorized Official

Name: DR. TIMOTHY A BRAY
Title: OWNER / DENTIST
Phone: (651) 426-0011

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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Individual Providers

Provider Name	Specialty	City
Bradley John Hagen	Dentist - General Practice	Mahtomedi	AI Deep Dive
DR. Perri Lynn Kauls, D.D.S.	Dentist - General Practice	Mahtomedi	AI Deep Dive
MR. Michael J Fasbender, DDS	Dentist - General Practice	Austin	AI Deep Dive

Organizations

Provider Name	Specialty	City
Mahtomedi Family Dental	Dentist - General Practice	Mahtomedi	AI Deep Dive
Mahtomedi Dental Clinic	Dentist - General Practice	Mahtomedi	AI Deep Dive

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