Provider Demographics
NPI:1518231596
Name:WOODBURY DENTAL ARTS
Entity Type:Organization
Organization Name:WOODBURY DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-808-7731
Mailing Address - Street 1:237 RADIO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4478
Mailing Address - Country:US
Mailing Address - Phone:651-436-7559
Mailing Address - Fax:651-436-7553
Practice Address - Street 1:237 RADIO DR STE 110
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4478
Practice Address - Country:US
Practice Address - Phone:651-436-7559
Practice Address - Fax:651-436-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty