Provider Demographics
NPI:1477392116
Name:AFFORDABLE DENTURES & IMPLANTS - COON RAPIDS, P.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - COON RAPIDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-371-0845
Mailing Address - Street 1:12761 RIVERDALE BLVD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1260
Mailing Address - Country:US
Mailing Address - Phone:320-371-0845
Mailing Address - Fax:
Practice Address - Street 1:12761 RIVERDALE BLVD NW STE 103
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1260
Practice Address - Country:US
Practice Address - Phone:320-371-0845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty