Provider Demographics
NPI:1316260516
Name:THE DENTAL CENTER OF EAGAN
Entity type:Organization
Organization Name:THE DENTAL CENTER OF EAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-788-7924
Mailing Address - Street 1:3348 SHERMAN CT
Mailing Address - Street 2:STE 202
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5006
Mailing Address - Country:US
Mailing Address - Phone:651-788-7924
Mailing Address - Fax:651-756-8131
Practice Address - Street 1:3348 SHERMAN CT
Practice Address - Street 2:STE 202
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5006
Practice Address - Country:US
Practice Address - Phone:651-788-7924
Practice Address - Fax:651-756-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental