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General NPI Number Information
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NPI Number | 1790442176
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Entity Type | Organization
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Legal Business Name | THE DENTAL SUITE PLLC
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Dates
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Enumeration Date | 11/20/2021
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 4930 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1731
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Country | US
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Telephone | 763-245-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 9756 WASHBURN AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55444-1016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MUDASIR WALJI
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Credential | DDS
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Telephone | 763-537-4531
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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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