Provider Demographics
NPI:1922526334
Name:ALL SMILES DENTAL PA
Entity Type:Organization
Organization Name:ALL SMILES DENTAL PA
Other - Org Name:ALL SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-239-5072
Mailing Address - Street 1:8812 138TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3130
Mailing Address - Country:US
Mailing Address - Phone:952-239-5951
Mailing Address - Fax:
Practice Address - Street 1:212 CLYDESDALE TRL
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-4513
Practice Address - Country:US
Practice Address - Phone:952-239-5072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty