Healthcare Provider Details

I. General information

NPI: 1417893017
Provider Name (Legal Business Name): SLP DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 UTICA AVE S APT 421
ST LOUIS PARK MN
55416-4596
US

IV. Provider business mailing address

1325 UTICA AVE S APT 421
ST LOUIS PARK MN
55416-4596
US

V. Phone/Fax

Practice location:
  • Phone: 980-349-1066
  • Fax:
Mailing address:
  • Phone: 980-349-1066
  • Fax:

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: AMIRALI BEHDANI
Title or Position: DENTIST
Credential:
Phone: 980-349-1066