Provider Demographics
NPI:1235370420
Name:METROPOLITAN PROSTHODONTICS PA
Entity Type:Organization
Organization Name:METROPOLITAN PROSTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SASIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-559-7600
Mailing Address - Street 1:3455 PLYMOUTH BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1540
Mailing Address - Country:US
Mailing Address - Phone:763-559-7600
Mailing Address - Fax:763-559-7604
Practice Address - Street 1:3455 PLYMOUTH BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1540
Practice Address - Country:US
Practice Address - Phone:763-559-7600
Practice Address - Fax:763-559-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10756261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental