State of Minnesota - Minnesota Management and Budget

NPI #1609682855 in Preston, Minnesota

Provider Information

NPI Number: 1609682855
Entity Type: Organization
Organization Name: State of Minnesota - Minnesota Management and Budget
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 3, 2024
Last Updated: Dec 3, 2024

Practice Location

Address: 1864 FIRST MINNESOTA
City: Preston
State: Minnesota
ZIP Code: 55965-2823
Phone: (651) 396-6260

Authorized Official

Name: SIMONE RENEE HOGAN
Title: MDVA HEALTHCARE OPERATIONS DIRECTOR
Phone: (612) 505-4110

Specialties & Taxonomy Codes

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

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