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123 Brush Dental LLC — NPI 1053807016, Maplewood, MN | NPI Central

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OrganizationActive

123 Brush Dental LLC

NPI 1053807016 · Dental Clinic/Center · Maplewood, MN

Provider details

NPI number: 1053807016
Entity type: Organization
Primary specialty: Dental Clinic/CenterAmbulatory Health Care Facilities
Authorized official: Vacharee Peterson, Dentist
License: D9309 (MN)

Practice location

1670 Beam Ave

Ste 202

Maplewood, MN 55109

Phone: (651) 779-4195

More MN providers

Mailing address

1670 Beam Ave

Maplewood, MN 55109

Registry dates

Enumerated: 2018-07-02
Last updated: 2018-07-02

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.