Provider Demographics
NPI:1275280810
Name:COMMUNITY DENTAL CARE INC
Entity Type:Organization
Organization Name:COMMUNITY DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-925-8400
Mailing Address - Street 1:1670 BEAM AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1227
Mailing Address - Country:US
Mailing Address - Phone:651-925-8400
Mailing Address - Fax:
Practice Address - Street 1:3650 BRADDOCK AVE NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-3666
Practice Address - Country:US
Practice Address - Phone:651-925-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty