Provider Demographics
NPI:1629538988
Name:MISO DENTISTRY, PC
Entity Type:Organization
Organization Name:MISO DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYEOK
Authorized Official - Middle Name:JE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:763-331-5816
Mailing Address - Street 1:6240 QUINWOOD LN N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6384
Mailing Address - Country:US
Mailing Address - Phone:763-331-5816
Mailing Address - Fax:763-391-6574
Practice Address - Street 1:6240 QUINWOOD LN N # 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6384
Practice Address - Country:US
Practice Address - Phone:763-391-6486
Practice Address - Fax:763-710-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty