Provider Demographics
NPI:1154568293
Name:DULAC DENTAL LTD
Entity type:Organization
Organization Name:DULAC DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DULAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-925-2176
Mailing Address - Street 1:6550 YORK AVE S STE 202
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2333
Mailing Address - Country:US
Mailing Address - Phone:952-925-2176
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S STE 202
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2333
Practice Address - Country:US
Practice Address - Phone:952-925-2176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty