OrganizationJames G Koller Dds,PaClinic/CenterAmbulatory Health Care FacilitiesPractice Address2601 Centennial Dr Ste 102, North St Paul, MN 55109-3087(651) 777-6454PECOS EnrollmentBased on the most recent information from CMS, provider James G Koller Dds,Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1174989743Provider TypeOrganizationFull NameJames G Koller Dds,PaSubpartNoEnumeration Date1/12/2016Last Updated12/5/2019Contact InformationPractice LocationPractice Address2601 Centennial Dr Ste 102, North St Paul, MN 55109-3087Phone(651) 777-6454Fax(651) 773-9206Mailing LocationMailing Address2601 Centennial Dr Ste 102, North St Paul, MN 55109-3087Phone(651) 777-6454Fax(651) 773-9206Authorized OfficialNameKoller, James G (Dentist)Phone(651) 777-6454Provider TaxonomiesCodeDescriptionLicenseCode261QD0000XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicense10366Minnesota