Provider Demographics
NPI:1114208014
Name:UPTOWN DENTAL ASSOCIATES,PA
Entity Type:Organization
Organization Name:UPTOWN DENTAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-377-5033
Mailing Address - Street 1:141 E WILLIAM ST
Mailing Address - Street 2:P.O. BOX 36
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2530
Mailing Address - Country:US
Mailing Address - Phone:507-377-5033
Mailing Address - Fax:507-369-0090
Practice Address - Street 1:141 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2530
Practice Address - Country:US
Practice Address - Phone:507-377-5033
Practice Address - Fax:507-369-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11601261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental