Provider Demographics
NPI:1861138133
Name:DOWNTOWN PERIODONTICS AND IMPLANT DENTISTRY
Entity type:Organization
Organization Name:DOWNTOWN PERIODONTICS AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-339-5593
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 725
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402
Mailing Address - Country:US
Mailing Address - Phone:612-339-5593
Mailing Address - Fax:612-324-3136
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 725
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402
Practice Address - Country:US
Practice Address - Phone:612-339-5593
Practice Address - Fax:612-324-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty