Provider Demographics
NPI:1760852487
Name:CHANHASSEN SMILES DENTISTRY, PC
Entity Type:Organization
Organization Name:CHANHASSEN SMILES DENTISTRY, PC
Other - Org Name:CHANHASSEN SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEBHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-303-1737
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:190 LAKE DRIVE E
Practice Address - Street 2:SUITE 130
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55319
Practice Address - Country:US
Practice Address - Phone:952-303-1737
Practice Address - Fax:952-937-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty