Provider Demographics
NPI:1891867941
Name:CHASKA DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:CHASKA DENTAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-448-4151
Mailing Address - Street 1:2634 SHADOW LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1119
Mailing Address - Country:US
Mailing Address - Phone:952-448-4151
Mailing Address - Fax:952-448-6856
Practice Address - Street 1:2634 SHADOW LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1119
Practice Address - Country:US
Practice Address - Phone:952-448-4151
Practice Address - Fax:952-448-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND102521223G0001X
MND114871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty