Healthcare Provider Details

I. General information

NPI: 1689355331
Provider Name (Legal Business Name): LITTLE CANADA DENTAL OFFICE, ALI R SALMANPOUR DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LITTLE CANADA ROAD E
LITTLE CANADA MN
55117
US

IV. Provider business mailing address

188 LITTLE CANADA ROAD E
LITTLE CANADA MN
55117
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-7725
  • Fax: 651-484-7768
Mailing address:
  • Phone: 651-484-7725
  • Fax: 651-484-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALI R. SALMANPOUR
Title or Position: DENTIST
Credential: DDS
Phone: 651-484-7725