Provider Demographics
NPI:1386189801
Name:ON-SITE DENTISTRY
Entity Type:Organization
Organization Name:ON-SITE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FINCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-961-0866
Mailing Address - Street 1:7600 FRANCE AVE. S.
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-5924
Mailing Address - Country:US
Mailing Address - Phone:763-545-7545
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:7600 FRANCE AVE. S.
Practice Address - Street 2:SUITE 1100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55130-5924
Practice Address - Country:US
Practice Address - Phone:763-545-7545
Practice Address - Fax:952-929-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
MN251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty