Provider Demographics
NPI:1144600859
Name:CAMILLE ZELEN DDS PA
Entity Type:Organization
Organization Name:CAMILLE ZELEN DDS PA
Other - Org Name:MOUNT ROYAL DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ZELEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-464-5222
Mailing Address - Street 1:1624 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2628
Mailing Address - Country:US
Mailing Address - Phone:218-464-5222
Mailing Address - Fax:218-464-5229
Practice Address - Street 1:1624 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2628
Practice Address - Country:US
Practice Address - Phone:218-464-5222
Practice Address - Fax:218-464-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty