Healthcare Provider Details

I. General information

NPI: 1235042565
Provider Name (Legal Business Name): ADVANCED DENTAL LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7362 UNIVERSITY AVE NE STE 300
FRIDLEY MN
55432-3150
US

IV. Provider business mailing address

7362 UNIVERSITY AVE NE STE 300
FRIDLEY MN
55432-3150
US

V. Phone/Fax

Practice location:
  • Phone: 763-571-4887
  • Fax:
Mailing address:
  • Phone: 763-571-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: HASS H SALTI
Title or Position: OWNER
Credential: CDT
Phone: 763-528-0775