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Northern Star Oral And Maxillofacial Surgery Pllc
Oral and Maxillofacial Surgery Clinic/Center in St Louis Park, Minnesota
NPI 1699901140

Northern Star Oral And Maxillofacial Surgery Pllc is a Oral and Maxillofacial Surgery Clinic/Center based in St Louis Park, MN and is specialized in Oral and Maxillofacial Surgery. Northern Star Oral And Maxillofacial Surgery Pllc practices in St Louis Park, MN. The NPI Number for Northern Star Oral And Maxillofacial Surgery Pllc is 1699901140 and holds a License No. D11399 (Minnesota).

The current practice location address for Northern Star Oral And Maxillofacial Surgery Pllc is 5100 Gamble Dr, St Louis Park, MN and can be reached out via phone at 952-465-0105 and via fax at 952-465-0106.

Location: 5100 Gamble Dr, St Louis Park, MN, 55416-1585
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1699901140
Provider Name
Northern Star Oral And Maxillofacial Surgery Pllc
Credential
Provider Entity Type
Organization
Address
5100 Gamble Dr, St Louis Park, MN, 55416-1585
Phone Number
952-465-0105
Fax Number
952-465-0106
Provider Enumeration Date
06/10/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CO5268 01 MN MEDICARE PTAN
DQ4459 01 MN MEDICARE RAILROAD PTAN
187847 01 MN U CARE
3AI37NO 01 MN BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
5100 Gamble Dr
City
St Louis Park
State
Minnesota
Zip
55416-1585
Phone Number
952-465-0105
Fax Number
952-465-0106
person
Provider Business Mailing Address Details
Address
5100 Gamble Dr
City
St Louis Park
State
Minnesota
Zip
55416-1585
Phone Number
952-465-0105
Fax Number
952-465-0106
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Oral and Maxillofacial Surgery
Taxonomy
261QS0112X
License No.
D11399 (Minnesota)
Definition
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.
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