Provider Demographics
NPI:1508039785
Name:CLASEN FAMILY DENTAL
Entity Type:Organization
Organization Name:CLASEN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLASEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-739-0640
Mailing Address - Street 1:1789 WOODLANE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3910
Mailing Address - Country:US
Mailing Address - Phone:651-739-0640
Mailing Address - Fax:651-739-0642
Practice Address - Street 1:1789 WOODLANE DR
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3910
Practice Address - Country:US
Practice Address - Phone:651-739-0640
Practice Address - Fax:651-739-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty