Organization · Type 2 NPI

ST Paul Oral Surgery and Dental Implants LLC

Oral and Maxillofacial Surgery (Dentist) · Mendota Heights, MN

NPI number 1124776687 Active

Practice location

750 Main St Ste 200
Mendota Heights, MN 55118-3767

Fax (651) 451-8010

Specialties and licenses

Taxonomy	Code	License
Oral and Maxillofacial Surgery (Dentist) Primary	1223S0112X	None listed

Oral and Maxillofacial Surgery (Dentist): 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.

NPI record

NPI: 1124776687
Entity type: Organization (Type 2)
Issued: Mar 14, 2022
Last updated: Mar 14, 2022
Status: Active
Subpart: Yes of ST Paul Oral Surgery and Dental Implants LLC

Other names

St. Paul Oral Surgery - Mendota Heights · doing business as

Authorized official

Celia Hayes
Credentialing Coordinator
(217) 540-2100

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1124776687

ST Paul Oral Surgery and Dental Implants LLC's National Provider Identifier is 1124776687, issued on Mar 14, 2022. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Mendota Heights, MN. The record was last updated on Mar 14, 2022.