Provider Demographics
NPI:1497218184
Name:ACTION DENTAL
Entity Type:Organization
Organization Name:ACTION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-458-6830
Mailing Address - Street 1:3701 W OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3555
Mailing Address - Country:US
Mailing Address - Phone:612-458-6830
Mailing Address - Fax:651-431-7462
Practice Address - Street 1:10584 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3538
Practice Address - Country:US
Practice Address - Phone:952-305-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTION FOR EAST AFRICAN PEOPLE AFEAP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental