Provider Demographics
NPI:1205228830
Name:APPLE TREE DENTAL CALIFORNIA, LLC
Entity Type:Organization
Organization Name:APPLE TREE DENTAL CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELGESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-600-6834
Mailing Address - Street 1:8960 SPRINGBROOK DR NW
Mailing Address - Street 2:SITE 150
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5852
Mailing Address - Country:US
Mailing Address - Phone:763-784-7993
Mailing Address - Fax:763-785-8960
Practice Address - Street 1:430 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3710
Practice Address - Country:US
Practice Address - Phone:763-600-6896
Practice Address - Fax:763-785-8960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLE TREE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental