Provider Demographics
NPI:1952867046
Name:TURTLE COVE DENTAL
Entity Type:Organization
Organization Name:TURTLE COVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-428-2300
Mailing Address - Street 1:PO BOX 270511
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0511
Mailing Address - Country:US
Mailing Address - Phone:651-366-6880
Mailing Address - Fax:651-366-6881
Practice Address - Street 1:14000 NORTHDALE BLVD STE J
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4663
Practice Address - Country:US
Practice Address - Phone:763-428-2300
Practice Address - Fax:763-428-4031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULOS DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental