Provider Demographics
NPI:1790941425
Name:AFFILIATED PEDIATRIC DENTISTS PA
Entity Type:Organization
Organization Name:AFFILIATED PEDIATRIC DENTISTS PA
Other - Org Name:DENTISTRY FOR CHILDREN & ADOLESCENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-831-4400
Mailing Address - Street 1:7373 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 402
Mailing Address - City:EDINA
Mailing Address - State:NE
Mailing Address - Zip Code:55435-4558
Mailing Address - Country:US
Mailing Address - Phone:952-831-4400
Mailing Address - Fax:952-893-3041
Practice Address - Street 1:6060 CLEARWATER DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9468
Practice Address - Country:US
Practice Address - Phone:952-932-0920
Practice Address - Fax:952-932-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty