Provider Demographics
NPI:1659458974
Name:UPTOWN DENTAL ACQUISITION COMPANY
Entity Type:Organization
Organization Name:UPTOWN DENTAL ACQUISITION COMPANY
Other - Org Name:UPTOWN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-827-3736
Mailing Address - Street 1:1406 W LAKE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2653
Mailing Address - Country:US
Mailing Address - Phone:612-827-3736
Mailing Address - Fax:612-821-9626
Practice Address - Street 1:1406 W LAKE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2653
Practice Address - Country:US
Practice Address - Phone:612-827-3736
Practice Address - Fax:612-821-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty