Provider Demographics
NPI:1518574532
Name:STILLWATER FAMILY DENTAL
Entity Type:Organization
Organization Name:STILLWATER FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALNIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-351-0890
Mailing Address - Street 1:13481 60TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1089
Mailing Address - Country:US
Mailing Address - Phone:651-351-0890
Mailing Address - Fax:651-351-1922
Practice Address - Street 1:13481 60TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-1089
Practice Address - Country:US
Practice Address - Phone:651-351-0890
Practice Address - Fax:651-351-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental