Provider Demographics
NPI:1790442176
Name:THE DENTAL SUITE PLLC
Entity Type:Organization
Organization Name:THE DENTAL SUITE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUDASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:WALJI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-537-4531
Mailing Address - Street 1:9756 WASHBURN AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4930 42ND AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1731
Practice Address - Country:US
Practice Address - Phone:763-245-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental