Provider Demographics
NPI:1558719922
Name:MSP DENTISTRY, INC.
Entity Type:Organization
Organization Name:MSP DENTISTRY, INC.
Other - Org Name:TWIN CITIES DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-421-7900
Mailing Address - Street 1:12027 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4526
Mailing Address - Country:US
Mailing Address - Phone:763-421-7900
Mailing Address - Fax:763-421-7916
Practice Address - Street 1:12027 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-4526
Practice Address - Country:US
Practice Address - Phone:763-421-7900
Practice Address - Fax:763-421-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12034305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization