Provider Demographics
NPI:1699842351
Name:PRESERVE DENTISTRY, PA
Entity Type:Organization
Organization Name:PRESERVE DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SETTERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-739-7888
Mailing Address - Street 1:7582 CURRELL BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2262
Mailing Address - Country:US
Mailing Address - Phone:651-739-7888
Mailing Address - Fax:
Practice Address - Street 1:7582 CURRELL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2262
Practice Address - Country:US
Practice Address - Phone:651-739-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND110371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty