Provider Demographics
NPI:1841452398
Name:HARBOR PLACE DENTAL ASSOCIATES, LTD
Entity type:Organization
Organization Name:HARBOR PLACE DENTAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PLETSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-484-9229
Mailing Address - Street 1:470 HIGHWAY 96 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1996
Mailing Address - Country:US
Mailing Address - Phone:651-484-9229
Mailing Address - Fax:651-484-9221
Practice Address - Street 1:470 HIGHWAY 96 W
Practice Address - Street 2:SUITE 200
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1996
Practice Address - Country:US
Practice Address - Phone:651-484-9229
Practice Address - Fax:651-484-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN682222300OtherMEDICAL ASSISTANCE