Periodontal Center
Dentist, Periodontics in Hudson, WI. Organization (NPI-2).
NPI number1497348239
StatusActive
Last updated in NPPESFeb 12, 2021
Details
- NPI
- 1497348239
- Entity type
- Organization (NPI-2)
- Legal business name
- Periodontal Center
- Organization subpart
- No
- Enumeration date
- Feb 12, 2021
- Certification date
- Feb 12, 2021
- Last updated
- Feb 12, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | – | – | Yes |
Other names
- The Periodontal Center (Doing Business As)
Practice location
1610 Maxwell DrHudson, WI 54016-8709
Phone 715-690-3050
Mailing address
8401 Seasons PkwyWoodbury, MN 55125-3414
Other practice locations
7791 79th St S
Cottage Grove, MN 55016-1832
Cottage Grove, MN 55016-1832
Phone 715-690-3050
Authorized official
Patty Barnard
Business Manager
6512332140
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