Provider Demographics
NPI:1073360970
Name:BUFFALO FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:BUFFALO FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GREAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-682-6885
Mailing Address - Street 1:106 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2956
Mailing Address - Country:US
Mailing Address - Phone:763-458-3428
Mailing Address - Fax:
Practice Address - Street 1:106 CENTER DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2956
Practice Address - Country:US
Practice Address - Phone:763-458-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental