=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689355331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE CANADA DENTAL OFFICE, ALI R SALMANPOUR DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2023
-----------------------------------------------------
Last Update Date | 07/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 188 LITTLE CANADA ROAD E
-----------------------------------------------------
City | LITTLE CANADA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-484-7725
-----------------------------------------------------
Fax | 651-484-7768
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 LITTLE CANADA ROAD E
-----------------------------------------------------
City | LITTLE CANADA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-484-7725
-----------------------------------------------------
Fax | 651-484-7768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | ALI R. SALMANPOUR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 651-484-7725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------