Provider Demographics
NPI:1700209194
Name:BLUE SKY DENTAL, PLLC
Entity Type:Organization
Organization Name:BLUE SKY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:LANGTON-YANOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-258-5260
Mailing Address - Street 1:18 3RD ST SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3024
Mailing Address - Country:US
Mailing Address - Phone:507-258-5260
Mailing Address - Fax:
Practice Address - Street 1:18 3RD ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3024
Practice Address - Country:US
Practice Address - Phone:507-258-5260
Practice Address - Fax:815-346-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty