Dental South PA

NPI #1558431890 in South St Paul, Minnesota

Provider Information

NPI Number: 1558431890
Entity Type: Organization
Organization Name: Dental South PA
Subpart: Yes (part of a larger organization)
Parent Organization: DENTAL SOUTH PA
Primary Specialty: Dentist
Enumeration Date: Nov 8, 2006
Last Updated: Dec 2, 2019

Practice Location

Address: 800 MARIE AVENUE
City: South St Paul
State: Minnesota
ZIP Code: 55075
Phone: (651) 451-1277

Authorized Official

Name: MICHAEL J. PRUEHER, D.D.S.
Title: OWNER/DENTIST
Phone: (651) 451-1277

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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