Provider Demographics
NPI:1922144971
Name:STRAIT SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:STRAIT SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-873-6380
Mailing Address - Street 1:201 W RAVEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1704
Mailing Address - Country:US
Mailing Address - Phone:952-873-6380
Mailing Address - Fax:952-873-6382
Practice Address - Street 1:201 W RAVEN ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-1704
Practice Address - Country:US
Practice Address - Phone:952-873-6380
Practice Address - Fax:952-873-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty