Healthcare Provider Details

I. General information

NPI: 1578158929
Provider Name (Legal Business Name): URGENT CARE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 42ND AVE N
NEW HOPE MN
55427
US

IV. Provider business mailing address

8500 42ND AVE N
NEW HOPE MN
55427
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-8916
  • Fax: 763-205-4564
Mailing address:
  • Phone: 763-762-8916
  • Fax: 763-205-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUKTAR A FARAH
Title or Position: CEO
Credential: DDS
Phone: 612-442-3847