Provider Demographics
NPI:1811392665
Name:AKSHAAN PLLC
Entity Type:Organization
Organization Name:AKSHAAN PLLC
Other - Org Name:TAMARACK HILLS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-964-3747
Mailing Address - Street 1:707 BIELENBERG DR
Mailing Address - Street 2:SUITE101
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1426
Mailing Address - Country:US
Mailing Address - Phone:651-964-3747
Mailing Address - Fax:
Practice Address - Street 1:707 BIELENBERG DR
Practice Address - Street 2:SUITE101
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1426
Practice Address - Country:US
Practice Address - Phone:651-304-6017
Practice Address - Fax:651-964-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty