Provider Demographics
NPI:1255880944
Name:SALUTE DENTAL
Entity type:Organization
Organization Name:SALUTE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-209-0270
Mailing Address - Street 1:2101 WOODWINDS DRIVE
Mailing Address - Street 2:SUITE #500
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2527
Mailing Address - Country:US
Mailing Address - Phone:651-209-0270
Mailing Address - Fax:
Practice Address - Street 1:2101 WOODWINDS DR STE 500
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2527
Practice Address - Country:US
Practice Address - Phone:651-209-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71611223G0001X
MN124121223G0001X
MN108931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty