Provider Demographics
NPI:1114207362
Name:TRANQUILITY DENTAL, P.A.
Entity type:Organization
Organization Name:TRANQUILITY DENTAL, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAIDYHORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-334-3304
Mailing Address - Street 1:7415 WAYZATA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1607
Mailing Address - Country:US
Mailing Address - Phone:952-334-3304
Mailing Address - Fax:
Practice Address - Street 1:7415 WAYZATA BLVD
Practice Address - Street 2:STE 201
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1607
Practice Address - Country:US
Practice Address - Phone:952-334-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND94601223G0001X
MND122471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty