Provider Demographics
NPI:1871837708
Name:DENTALIGN, P.A
Entity Type:Organization
Organization Name:DENTALIGN, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:HOLLY
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:763-420-1030
Mailing Address - Street 1:10617 FRANCE AVENUE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431
Mailing Address - Country:US
Mailing Address - Phone:763-420-1030
Mailing Address - Fax:430-420-5510
Practice Address - Street 1:4630 EDGEBROOK PL
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1152
Practice Address - Country:US
Practice Address - Phone:763-420-1030
Practice Address - Fax:730-420-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty