Provider Demographics
NPI:1295858991
Name:DENTAL DELIVERY SYSTEMS ST PAUL, PA
Entity Type:Organization
Organization Name:DENTAL DELIVERY SYSTEMS ST PAUL, PA
Other - Org Name:DENTAL ASSOCIATES OF ST. PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-735-0595
Mailing Address - Street 1:1790 7TH STREET E.
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119
Mailing Address - Country:US
Mailing Address - Phone:651-735-0595
Mailing Address - Fax:651-735-0521
Practice Address - Street 1:1790 7TH STREET E.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119
Practice Address - Country:US
Practice Address - Phone:651-735-0595
Practice Address - Fax:651-735-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty