Provider Demographics
NPI:1578158929
Name:URGENT CARE DENTAL PLLC
Entity Type:Organization
Organization Name:URGENT CARE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUKTAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-707-3768
Mailing Address - Street 1:1320 W LAKE ST APT 521
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4987
Mailing Address - Country:US
Mailing Address - Phone:612-707-3768
Mailing Address - Fax:
Practice Address - Street 1:331 WILLOW BND APT 705
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3969
Practice Address - Country:US
Practice Address - Phone:612-707-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental