Provider Demographics
NPI:1528558244
Name:ON-SITE DENTISTRY
Entity Type:Organization
Organization Name:ON-SITE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-545-7545
Mailing Address - Street 1:7600 FRANCE AVE S STE 1100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5936
Mailing Address - Country:US
Mailing Address - Phone:763-545-7545
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:7600 FRANCE AVE S STE 1100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5936
Practice Address - Country:US
Practice Address - Phone:763-545-7545
Practice Address - Fax:952-929-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty