Provider Demographics
NPI:1639337710
Name:BLUE RIDGE DENTAL CENTER PA
Entity Type:Organization
Organization Name:BLUE RIDGE DENTAL CENTER PA
Other - Org Name:BLUE RIDGE DENTAL CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAMPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-938-8858
Mailing Address - Street 1:13800 83RD WAY N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7016
Mailing Address - Country:US
Mailing Address - Phone:763-424-2877
Mailing Address - Fax:
Practice Address - Street 1:13800 83RD WAY N STE 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7016
Practice Address - Country:US
Practice Address - Phone:763-424-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty