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 today at 10:51 AM.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