Provider Demographics
NPI:1629758305
Name:LERVICK DENTISTRY PLLC
Entity Type:Organization
Organization Name:LERVICK DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:LERVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-746-0225
Mailing Address - Street 1:5201 EDEN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2358
Mailing Address - Country:US
Mailing Address - Phone:952-746-0225
Mailing Address - Fax:952-746-0227
Practice Address - Street 1:5201 EDEN AVE STE 120
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2358
Practice Address - Country:US
Practice Address - Phone:952-746-0225
Practice Address - Fax:952-746-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental