MEDICARE: DENTAL DELLIVERY SYSTEMS BROOKLYN PARK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11353	MN

General Provider Information

NPI Number	:	1275704520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DELLIVERY SYSTEMS BROOKLYN PARK PA

Provider Business Mailing Address
First Line	:	7532 BROOKLYN BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55443-3101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7532 BROOKLYN BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55443-3101
Country	:	US
Telephone Number	:	763-263-2222
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	DR. THANH PHAM
Credential	:	DDS
Telephone Number	:	763-263-2222

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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