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General NPI Number Information
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NPI Number | 1801068663
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Entity Type | Organization
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Legal Business Name | PLYMOUTH STATION DENTAL, PA
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 16795 COUNTY ROAD 24 SUITE 6
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City | PLYMOUTH
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State | MN
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Zip | 55447-1201
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Country | US
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Telephone | 763-511-9840
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Fax |
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Provider Business Mailing Address
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Address Line | 16795 COUNTY ROAD 24 SUITE 6
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City | PLYMOUTH
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State | MN
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Zip | 55447-1201
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Country | US
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Telephone | 763-511-9840
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Fax |
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Authorized Official
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Title or Position | D.D.S. OWNER
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Name | DR. ROBERT MICHAEL SINKO
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Credential |
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Telephone | 763-577-9840
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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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