Provider Demographics
NPI:1770190951
Name:FOREVER SMILES PARTNERS PLLC
Entity Type:Organization
Organization Name:FOREVER SMILES PARTNERS PLLC
Other - Org Name:BLUFF CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:IBBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-227-5549
Mailing Address - Street 1:600 MARKET ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4570
Mailing Address - Country:US
Mailing Address - Phone:952-937-5200
Mailing Address - Fax:
Practice Address - Street 1:600 MARKET ST STE 130
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4570
Practice Address - Country:US
Practice Address - Phone:952-937-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1720165905Medicaid
MN1225140593OtherCMS
MN1447691431Medicaid