Provider Demographics
NPI:1326156910
Name:ECKART DENTAL CENTER LLC
Entity Type:Organization
Organization Name:ECKART DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-445-1352
Mailing Address - Street 1:300 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1444
Mailing Address - Country:US
Mailing Address - Phone:952-445-1352
Mailing Address - Fax:952-445-7221
Practice Address - Street 1:300 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1444
Practice Address - Country:US
Practice Address - Phone:952-445-1352
Practice Address - Fax:952-445-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03905ECOtherBCBS #
MN4040598OtherMEDICA