Provider Demographics
NPI:1346462355
Name:CROSSINGS DENTAL CARE
Entity Type:Organization
Organization Name:CROSSINGS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-224-8090
Mailing Address - Street 1:8170 OLD CARRIAGE CT STE 150
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3163
Mailing Address - Country:US
Mailing Address - Phone:952-224-8090
Mailing Address - Fax:952-224-8095
Practice Address - Street 1:8170 OLD CARRIAGE CT STE 150
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3163
Practice Address - Country:US
Practice Address - Phone:952-224-8090
Practice Address - Fax:952-224-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty