Provider Demographics
NPI:1205261195
Name:CITY CENTER DENTAL, L.L.C.
Entity type:Organization
Organization Name:CITY CENTER DENTAL, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHMIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-739-8573
Mailing Address - Street 1:8375 CITY CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3324
Mailing Address - Country:US
Mailing Address - Phone:651-739-8573
Mailing Address - Fax:651-739-5517
Practice Address - Street 1:8375 CITY CENTRE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3324
Practice Address - Country:US
Practice Address - Phone:651-739-8573
Practice Address - Fax:651-739-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND110401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty