Provider Demographics
NPI:1326285214
Name:NEWHOPE DENTAL PA
Entity Type:Organization
Organization Name:NEWHOPE DENTAL PA
Other - Org Name:DR.KING'S DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:763-746-8419
Mailing Address - Street 1:2738 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2850
Mailing Address - Country:US
Mailing Address - Phone:763-544-5919
Mailing Address - Fax:
Practice Address - Street 1:2738 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2850
Practice Address - Country:US
Practice Address - Phone:763-544-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWHOPEDENTAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10360302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization