Provider Demographics
NPI:1891979050
Name:CAHILL DENTAL CARE PA
Entity Type:Organization
Organization Name:CAHILL DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-451-9101
Mailing Address - Street 1:6105 CAHILL AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1525
Mailing Address - Country:US
Mailing Address - Phone:651-451-9101
Mailing Address - Fax:651-451-9887
Practice Address - Street 1:6105 CAHILL AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1525
Practice Address - Country:US
Practice Address - Phone:651-451-9101
Practice Address - Fax:651-451-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31424231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013999309OtherDENTIST
MN1174633823OtherPERIODONTIST
MN1942282231OtherDENTIST
MN1891777454OtherDENTIST