Provider Demographics
NPI:1659974665
Name:SERENITY DENTAL CORPORATION
Entity Type:Organization
Organization Name:SERENITY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-414-0208
Mailing Address - Street 1:563 BEIELBERG DRIVE
Mailing Address - Street 2:210
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-414-0208
Mailing Address - Fax:651-414-0390
Practice Address - Street 1:563 BEIELBERG DRIVE
Practice Address - Street 2:210
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-414-0208
Practice Address - Fax:651-414-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty