MEDICARE: ALL ABOUT SMILES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D10333	MN

General Provider Information

NPI Number	:	1154763688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL ABOUT SMILES, INC

Provider Business Mailing Address
First Line	:	1611 COUNTY HIGHWAY 10
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2124
Country	:	US
Telephone Number	:	763-717-3989
Fax Number	:	763-717-3952

Provider Business Practice Location Address
First Line	:	1611 COUNTY HIGHWAY 10
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2124
Country	:	US
Telephone Number	:	763-717-3989
Fax Number	:	763-717-3952

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL DONALD RYNDERS
Credential	:	D.D.S.
Telephone Number	:	763-717-3989

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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