Provider Demographics
NPI:1508042672
Name:ST FRANCIS DENTAL CARE PA
Entity Type:Organization
Organization Name:ST FRANCIS DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HUETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-753-1900
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070
Mailing Address - Country:US
Mailing Address - Phone:763-753-1900
Mailing Address - Fax:763-753-4220
Practice Address - Street 1:3715 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070
Practice Address - Country:US
Practice Address - Phone:763-753-1900
Practice Address - Fax:763-753-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty