Provider Demographics
NPI:1497929947
Name:ALL FAMLIY DENTAL
Entity Type:Organization
Organization Name:ALL FAMLIY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:RUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:651-731-2141
Mailing Address - Street 1:1075 HADLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5951
Mailing Address - Country:US
Mailing Address - Phone:651-731-2141
Mailing Address - Fax:651-731-3601
Practice Address - Street 1:1075 HADLEY AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5951
Practice Address - Country:US
Practice Address - Phone:651-731-2141
Practice Address - Fax:651-731-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty