Provider Demographics
NPI:1013386796
Name:SYDLEWSKI ORTHODONTICS
Entity Type:Organization
Organization Name:SYDLEWSKI ORTHODONTICS
Other - Org Name:SIGNATURE ORTHODONTICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COODINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:REID
Authorized Official - Last Name:RAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-426-9986
Mailing Address - Street 1:2126 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2717
Mailing Address - Country:US
Mailing Address - Phone:651-426-9986
Mailing Address - Fax:
Practice Address - Street 1:1575 7TH ST W STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4252
Practice Address - Country:US
Practice Address - Phone:651-426-9986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty