Provider Demographics
NPI:1114575891
Name:SHAKTI DENTAL P.C.
Entity Type:Organization
Organization Name:SHAKTI DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-695-6535
Mailing Address - Street 1:1541 CAMDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-2303
Mailing Address - Country:US
Mailing Address - Phone:605-695-6535
Mailing Address - Fax:
Practice Address - Street 1:17909 DELTON AVE
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-474-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental