Provider Demographics
NPI:1306853437
Name:AFFILIATED PEDIATRIC DENTISTS PA
Entity Type:Organization
Organization Name:AFFILIATED PEDIATRIC DENTISTS PA
Other - Org Name:DENTISTRY FOR CHILDREN AND ADOLESCENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-831-4400
Mailing Address - Street 1:7373 FRANCE AVE SO
Mailing Address - Street 2:SUITE 402
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4598
Mailing Address - Country:US
Mailing Address - Phone:952-831-4400
Mailing Address - Fax:952-893-3041
Practice Address - Street 1:7373 FRANCE AVE SO
Practice Address - Street 2:SUITE 402
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4598
Practice Address - Country:US
Practice Address - Phone:952-831-4400
Practice Address - Fax:952-893-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty