Provider Demographics
NPI:1245315829
Name:EXCELSIOR FAMILY DENTAL
Entity type:Organization
Organization Name:EXCELSIOR FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-474-6515
Mailing Address - Street 1:348 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1830
Mailing Address - Country:US
Mailing Address - Phone:952-474-6515
Mailing Address - Fax:952-474-1206
Practice Address - Street 1:348 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1830
Practice Address - Country:US
Practice Address - Phone:952-474-6515
Practice Address - Fax:952-474-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26203-LLC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty