Provider Demographics
NPI:1104156405
Name:RELAXATION DENTISTRY
Entity type:Organization
Organization Name:RELAXATION DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:RUOHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-351-8282
Mailing Address - Street 1:1475 WHITE OAK DR
Mailing Address - Street 2:200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4571
Mailing Address - Country:US
Mailing Address - Phone:952-351-8282
Mailing Address - Fax:952-466-2777
Practice Address - Street 1:1475 WHITE OAK DR
Practice Address - Street 2:200
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4571
Practice Address - Country:US
Practice Address - Phone:952-351-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty