Provider Demographics
NPI:1003021239
Name:STAT DENTAL, INC
Entity Type:Organization
Organization Name:STAT DENTAL, INC
Other - Org Name:EMERGENCY DENTAL CARE USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-859-7359
Mailing Address - Street 1:15043 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-5618
Mailing Address - Country:US
Mailing Address - Phone:612-859-7359
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 432
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-778-9911
Practice Address - Fax:651-633-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental