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General NPI Number Information
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NPI Number | 1124529334
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Entity Type | Organization
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Legal Business Name | A.M DENTAL PROFESSIONALS P.A
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1036 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379
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Country | US
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Telephone | 952-445-6622
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Fax | 952-314-9610
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Provider Business Mailing Address
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Address Line | 1036 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1607
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Country | US
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Telephone | 952-445-6622
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Fax | 952-314-9610
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Authorized Official
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Title or Position | OWNER
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Name | AYESHA DOWNS
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Credential | BDS
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Telephone | 952-445-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D12357
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License Number State | MN
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