=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265143671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCHORED ORTHODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2022
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17809 HUTCHINS DR STE 101
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55345-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-889-7211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5009 WILLISTON RD
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55345-4642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-889-7211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST/OWNER
-----------------------------------------------------
Name | DR. MOLLY DILLON MCMAHON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 612-889-7211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------