Provider Demographics
NPI:1013081736
Name:DENTAL ASSOCIATES-ESKO INCORPORATED P C
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES-ESKO INCORPORATED P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOPALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:IX
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-879-8355
Mailing Address - Street 1:4 W HIGHWAY 61
Mailing Address - Street 2:PO BOX 394
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-9701
Mailing Address - Country:US
Mailing Address - Phone:218-879-8355
Mailing Address - Fax:218-879-8352
Practice Address - Street 1:4 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:ESKO
Practice Address - State:MN
Practice Address - Zip Code:55733-0394
Practice Address - Country:US
Practice Address - Phone:218-879-8355
Practice Address - Fax:218-879-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN777522900Medicaid