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General NPI Number Information
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NPI Number | 1013111202
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Entity Type | Organization
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Legal Business Name | V DENTAL CENTER
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3903 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2520
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Country | US
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Telephone | 763-422-2000
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Fax | 763-427-5770
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Provider Business Mailing Address
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Address Line | 3903 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2520
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Country | US
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Telephone | 763-422-2000
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Fax | 763-427-5770
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. LEWIS T. YANG
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Credential |
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Telephone | 763-422-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10820
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D10987
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License Number State | MN
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