Provider Demographics
NPI:1952140691
Name:PL DENTAL SC
Entity type:Organization
Organization Name:PL DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:VINH
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-317-1166
Mailing Address - Street 1:9920 FOLEY BLVD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5216
Mailing Address - Country:US
Mailing Address - Phone:763-317-1166
Mailing Address - Fax:
Practice Address - Street 1:9920 FOLEY BLVD NW STE 110
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5216
Practice Address - Country:US
Practice Address - Phone:763-317-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PL DENTAL SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental