Provider Demographics
NPI:1538213566
Name:GROUP HEALTH PLAN, INC
Entity type:Organization
Organization Name:GROUP HEALTH PLAN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR AND SR. VICE PRESID
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:GESKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-883-7577
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21113A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5151
Mailing Address - Fax:952-883-5160
Practice Address - Street 1:2251 CONNECTICUT AVE
Practice Address - Street 2:HEALTHPARTNERS CENTRAL MN CLINIC - DENTAL
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56337-4772
Practice Address - Country:US
Practice Address - Phone:320-253-5824
Practice Address - Fax:320-203-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7477163-00Medicaid