Provider Demographics
NPI:1619011533
Name:OKANE AND MONSSEN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OKANE AND MONSSEN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-698-1242
Mailing Address - Street 1:2221 FORD PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1800
Mailing Address - Country:US
Mailing Address - Phone:651-698-1242
Mailing Address - Fax:651-696-1858
Practice Address - Street 1:2221 FORD PKWY
Practice Address - Street 2:STE 201
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1800
Practice Address - Country:US
Practice Address - Phone:651-698-1242
Practice Address - Fax:651-696-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty