Provider Demographics
NPI:1649497025
Name:YORK DENTAL P.L.L.C.
Entity type:Organization
Organization Name:YORK DENTAL P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FERRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-841-0122
Mailing Address - Street 1:3205 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5244
Mailing Address - Country:US
Mailing Address - Phone:952-841-0122
Mailing Address - Fax:952-896-0010
Practice Address - Street 1:3205 W 76TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5244
Practice Address - Country:US
Practice Address - Phone:952-841-0122
Practice Address - Fax:952-896-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31539831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty