Provider Demographics
NPI:1942436167
Name:CHILDLREN'S DENTAL CARE LLC
Entity Type:Organization
Organization Name:CHILDLREN'S DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-997-7100
Mailing Address - Street 1:17510 DODD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5268
Mailing Address - Country:US
Mailing Address - Phone:952-997-7100
Mailing Address - Fax:952-997-2017
Practice Address - Street 1:17510 DODD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5268
Practice Address - Country:US
Practice Address - Phone:952-997-7100
Practice Address - Fax:952-997-2017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S DENTAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-02
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73091223P0221X
MN119611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty