Provider Demographics
NPI:1215299508
Name:DENTISTRY FOR CHILDREN, P.A.
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:320-257-3380
Mailing Address - Street 1:140 TWIN RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2015
Mailing Address - Country:US
Mailing Address - Phone:320-257-3380
Mailing Address - Fax:320-257-3382
Practice Address - Street 1:140 TWIN RIVERS CT
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2015
Practice Address - Country:US
Practice Address - Phone:320-257-3380
Practice Address - Fax:320-257-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109201223P0221X
MND121661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN551219100Medicaid
MN1225195837Medicaid