Provider Demographics
NPI:1518139203
Name:SOFT DENTAL
Entity Type:Organization
Organization Name:SOFT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TUYEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-358-4733
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069-0643
Mailing Address - Country:US
Mailing Address - Phone:320-358-4733
Mailing Address - Fax:320-358-1073
Practice Address - Street 1:350 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-4733
Practice Address - Fax:320-358-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty