Provider Demographics
NPI:1780855171
Name:ESTHESIA ORAL SURGERY CARE, PA
Entity Type:Organization
Organization Name:ESTHESIA ORAL SURGERY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-920-3844
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-920-3844
Mailing Address - Fax:952-920-3008
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-920-3844
Practice Address - Fax:952-920-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96711223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03926Medicare PIN