Provider Demographics
NPI:1891091203
Name:PLYMOUTH FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:PLYMOUTH FAMILY DENTISTRY, LLC
Other - Org Name:FOUR SEASONS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ASHFAQUE HUSSAIN
Authorized Official - Last Name:ZOBAER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-559-2976
Mailing Address - Street 1:4205 LANCASTER LN N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1700
Mailing Address - Country:US
Mailing Address - Phone:763-559-2976
Mailing Address - Fax:763-559-4852
Practice Address - Street 1:4205 LANCASTER LN N
Practice Address - Street 2:SUITE 101
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1700
Practice Address - Country:US
Practice Address - Phone:763-559-2976
Practice Address - Fax:763-559-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental