Provider Demographics
NPI:1942481593
Name:MONTICELLO DENTAL GROUP
Entity Type:Organization
Organization Name:MONTICELLO DENTAL GROUP
Other - Org Name:MONTICELLO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CALPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-263-7100
Mailing Address - Street 1:20460 CO. RD.11 NW
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309
Mailing Address - Country:US
Mailing Address - Phone:763-263-7100
Mailing Address - Fax:
Practice Address - Street 1:20460 CO. RD.11 NW
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309
Practice Address - Country:US
Practice Address - Phone:763-263-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty