OrganizationActive
Bucca Dental LLC
NPI 1750774428 · Dental Clinic/Center · Minneapolis, MN
Provider details
- NPI number
- 1750774428
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Edgar Mantilla, Ceo(612) 724-1717
- License
- D11889 (MN)
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
1508 E Lake St
Minneapolis, MN 55407-1720
Phone: (612) 724-1717
Fax: (612) 724-3114
Approximate (ZIP-level) locationGet directions
Mailing address
1508 E Lake St
Minneapolis, MN 55407-1720
Registry dates
- Enumerated
- 2015-03-05
- Last updated
- 2015-03-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.