Provider Demographics
NPI:1497373195
Name:JAIN DENTAL ST. LOUIS PARK, PLLC
Entity Type:Organization
Organization Name:JAIN DENTAL ST. LOUIS PARK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-926-3392
Mailing Address - Street 1:4600 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4938
Mailing Address - Country:US
Mailing Address - Phone:952-926-3392
Mailing Address - Fax:
Practice Address - Street 1:4600 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4938
Practice Address - Country:US
Practice Address - Phone:952-926-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TROWBRIDGE ENTERPRISES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental