Provider Demographics
NPI:1942608377
Name:2010 DENTISTRY, PA
Entity Type:Organization
Organization Name:2010 DENTISTRY, PA
Other - Org Name:CROSSTOWN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MORK
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-866-5014
Mailing Address - Street 1:2010 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2127
Mailing Address - Country:US
Mailing Address - Phone:612-866-5014
Mailing Address - Fax:612-866-5082
Practice Address - Street 1:2010 W 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2127
Practice Address - Country:US
Practice Address - Phone:612-866-5014
Practice Address - Fax:612-866-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty