Provider Demographics
NPI:1689847519
Name:901 FAMILY DENTISTRY P.A.
Entity Type:Organization
Organization Name:901 FAMILY DENTISTRY P.A.
Other - Org Name:901 FAMILY DENTISTRY INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-789-9444
Mailing Address - Street 1:901 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3609
Mailing Address - Country:US
Mailing Address - Phone:612-789-9444
Mailing Address - Fax:612-789-2431
Practice Address - Street 1:901 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3609
Practice Address - Country:US
Practice Address - Phone:612-789-9444
Practice Address - Fax:612-789-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty