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General NPI Number Information
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NPI Number | 1578158929
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Entity Type | Organization
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Legal Business Name | URGENT CARE DENTAL PLLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 331 WILLOW BND APT 705
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City | CRYSTAL
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State | MN
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Zip | 55428-3969
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Country | US
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Telephone | 612-707-3768
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 W LAKE ST APT 521
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4987
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Country | US
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Telephone | 612-707-3768
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MUKTAR A FARAH
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Credential |
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Telephone | 612-707-3768
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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 |
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License Number State |
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