Provider Demographics
NPI:1033726161
Name:ALBERTVILLE FAMILY DENTAL
Entity Type:Organization
Organization Name:ALBERTVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:BECICKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-497-8165
Mailing Address - Street 1:5047 JASON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-9688
Mailing Address - Country:US
Mailing Address - Phone:763-497-8165
Mailing Address - Fax:763-497-8162
Practice Address - Street 1:5047 JASON AVE NE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-9688
Practice Address - Country:US
Practice Address - Phone:763-497-8165
Practice Address - Fax:763-497-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental