Provider Demographics
NPI:1598865651
Name:FAMILY ORAL SURGERY SPECIALISTS PLC
Entity Type:Organization
Organization Name:FAMILY ORAL SURGERY SPECIALISTS PLC
Other - Org Name:METRO DENTALCARE SPECIALTY CENTER RICHFIELD - ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:6601 LYNDALE AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S STE 230
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2479
Practice Address - Country:US
Practice Address - Phone:612-861-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY ORAL SURGERY SPECIALISTS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty