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General NPI Number Information
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NPI Number | 1588899199
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Entity Type | Organization
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Legal Business Name | COSMOPOLITAN ORTHODONTICS LLC
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 17757 JUNIPER PATH
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City | LAKEVILLE
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State | MN
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Zip | 55044-9482
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Country | US
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Telephone | 951-469-3333
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Fax | 951-469-4997
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Provider Business Mailing Address
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Address Line | 3340 SHERMAN CT
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City | EAGAN
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State | MN
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Zip | 55121-5012
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Country | US
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Telephone | 651-406-8100
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Fax | 651-406-8060
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. JENNIFER EISENHUTH
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Credential | DDS, MS
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Telephone | 952-469-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D10874
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License Number State | MN
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