Provider Demographics
NPI:1073970273
Name:SAINT ANTHONY PARK DENTAL CARE PLLC
Entity Type:Organization
Organization Name:SAINT ANTHONY PARK DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COGSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-644-3685
Mailing Address - Street 1:2278 COMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1794
Mailing Address - Country:US
Mailing Address - Phone:651-644-3685
Mailing Address - Fax:651-645-8097
Practice Address - Street 1:2278 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1794
Practice Address - Country:US
Practice Address - Phone:651-644-3685
Practice Address - Fax:651-645-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND133981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty