NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC NPI 1699901140

NPI Information

NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC is an oral and maxillofacial surgery clinic center in St Louis Park, MN. The provider is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC NPI is 1699901140. The provider is registered as an organization entity type.

The provider's business location address is:

5100 GAMBLE DR
SUITE 125
ST LOUIS PARK, MN
ZIP 55416-585
Phone: (952) 465-0105
Fax: (952) 465-0106

The provider's authorized official is Julie A Chavez .
The authorized official title is Owner and has the following contact phone number (952) 465-0105.

The CLIA number assigned to this NPI record is 24D2033286 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/10/2009 and was last updated on 6/23/2014.

Taxonomy Codes

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Other Identifiers

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