Provider Demographics
NPI:1801068663
Name:PLYMOUTH STATION DENTAL, PA
Entity type:Organization
Organization Name:PLYMOUTH STATION DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SINKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-577-9840
Mailing Address - Street 1:16795 COUNTY ROAD 24
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1201
Mailing Address - Country:US
Mailing Address - Phone:763-511-9840
Mailing Address - Fax:
Practice Address - Street 1:16795 COUNTY ROAD 24
Practice Address - Street 2:SUITE 6
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1201
Practice Address - Country:US
Practice Address - Phone:763-511-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental