Provider Demographics
NPI:1043429970
Name:BIRCHWOOD DENTAL OF MINNEAPOLIS
Entity Type:Organization
Organization Name:BIRCHWOOD DENTAL OF MINNEAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-333-8677
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:829 MEDICAL ARTS BLDG
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-333-8677
Mailing Address - Fax:612-333-7632
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:829 MEDICAL ARTS BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-333-8677
Practice Address - Fax:612-333-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty