Provider Demographics
NPI:1952918781
Name:ASP DENTAL, PC
Entity Type:Organization
Organization Name:ASP DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:945-250-3060
Mailing Address - Street 1:9800 SHELARD PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6451
Mailing Address - Country:US
Mailing Address - Phone:763-525-5011
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY STE 130
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6451
Practice Address - Country:US
Practice Address - Phone:763-525-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASP DENTAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental