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General NPI Number Information
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NPI Number | 1790941425
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Entity Type | Organization
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Legal Business Name | AFFILIATED PEDIATRIC DENTISTS PA
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 6060 CLEARWATER DRIVE SUITE 210
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City | MINNETONKA
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State | MN
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Zip | 55343-9468
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Country | US
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Telephone | 952-932-0920
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Fax | 952-932-0929
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Provider Business Mailing Address
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Address Line | 7373 FRANCE AVENUE SOUTH SUITE 402
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City | EDINA
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State | NE
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Zip | 55435-4558
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Country | US
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Telephone | 952-831-4400
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Fax | 952-893-3041
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Authorized Official
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Title or Position | TREASURER
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Name | DR. MARK EDWARD GREENWOOD
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Credential | D.D.S.
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Telephone | 952-831-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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