Provider Demographics
NPI:1285774398
Name:ASSOCIATED DENTAL
Entity type:Organization
Organization Name:ASSOCIATED DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-497-7730
Mailing Address - Street 1:4255 PHEASANT RIDGE DR NE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4537
Mailing Address - Country:US
Mailing Address - Phone:763-225-6100
Mailing Address - Fax:
Practice Address - Street 1:4255 PHEASANT RIDGE DR NE
Practice Address - Street 2:SUITE 407
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4537
Practice Address - Country:US
Practice Address - Phone:763-225-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty