Provider Demographics
NPI:1770503096
Name:ROSEVILLE FAMILY DENTAL CARE, P.A.
Entity Type:Organization
Organization Name:ROSEVILLE FAMILY DENTAL CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-489-0161
Mailing Address - Street 1:708 COUNTY ROAD B W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4527
Mailing Address - Country:US
Mailing Address - Phone:651-489-0161
Mailing Address - Fax:651-489-9938
Practice Address - Street 1:708 COUNTY ROAD B W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4527
Practice Address - Country:US
Practice Address - Phone:651-489-0161
Practice Address - Fax:651-489-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty