Provider Demographics
NPI:1124250873
Name:EXCEL DENTISTRY PLLC
Entity type:Organization
Organization Name:EXCEL DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALASSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-746-3233
Mailing Address - Street 1:6563 LAKETOWNE PL STE A
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6563 LAKETOWNE PL STE A
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4511
Practice Address - Country:US
Practice Address - Phone:952-746-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEL DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty