Healthcare Provider Details

I. General information

NPI: 1235370420
Provider Name (Legal Business Name): METROPOLITAN PROSTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PLYMOUTH BLVD SUITE 250
PLYMOUTH MN
55447-1540
US

IV. Provider business mailing address

3455 PLYMOUTH BLVD SUITE 250
PLYMOUTH MN
55447-1540
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-7600
  • Fax: 763-559-7604
Mailing address:
  • Phone: 763-559-7600
  • Fax: 763-559-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD10756
License Number StateMN

VIII. Authorized Official

Name: DR. CHRISTOPHER THOMAS SASIK
Title or Position: PRESIDENT
Credential: DDS
Phone: 763-559-7600