Provider Demographics
NPI:1932505583
Name:TWIN CITIES SEDATION DENTAL, P.A.
Entity Type:Organization
Organization Name:TWIN CITIES SEDATION DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MDH
Authorized Official - Phone:651-674-7096
Mailing Address - Street 1:6460 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-7068
Mailing Address - Country:US
Mailing Address - Phone:651-674-7096
Mailing Address - Fax:651-203-7373
Practice Address - Street 1:808 W BROADWAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-3769
Practice Address - Country:US
Practice Address - Phone:651-674-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental