Provider Demographics
NPI:1912458969
Name:ANOKA DENTAL PLLC
Entity Type:Organization
Organization Name:ANOKA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-746-8419
Mailing Address - Street 1:12 BRIDGE SQ
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2493
Mailing Address - Country:US
Mailing Address - Phone:763-421-4002
Mailing Address - Fax:763-231-7419
Practice Address - Street 1:12 BRIDGE SQ
Practice Address - Street 2:SUITE 106
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2493
Practice Address - Country:US
Practice Address - Phone:763-421-4002
Practice Address - Fax:763-231-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty