Provider Demographics
NPI:1518026806
Name:AFTON ROAD DENTAL ASSOC
Entity Type:Organization
Organization Name:AFTON ROAD DENTAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-739-5110
Mailing Address - Street 1:2716 UPPER AFTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4780
Mailing Address - Country:US
Mailing Address - Phone:651-739-5110
Mailing Address - Fax:651-739-1873
Practice Address - Street 1:2716 UPPER AFTON ROAD
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4780
Practice Address - Country:US
Practice Address - Phone:651-739-5110
Practice Address - Fax:651-739-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty