Healthcare Provider Details

I. General information

NPI: 1740455773
Provider Name (Legal Business Name): BISMILLAH DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 PENN AVE S SUITE 202
BLOOMINGTON MN
55431-2068
US

IV. Provider business mailing address

8900 PENN AVE S SUITE 202
BLOOMINGTON MN
55431-2068
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-1861
  • Fax: 952-888-1883
Mailing address:
  • Phone: 952-888-1861
  • Fax: 952-888-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. HASEEN SYED
Title or Position: OWNER/DR.
Credential: D.D.S.
Phone: 952-888-1861