Provider Demographics
NPI:1467268441
Name:PLATT DENTISTRY
Entity type:Organization
Organization Name:PLATT DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:KING
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-469-4588
Mailing Address - Street 1:11183 205TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9827
Mailing Address - Country:US
Mailing Address - Phone:952-469-4588
Mailing Address - Fax:
Practice Address - Street 1:11183 205TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9827
Practice Address - Country:US
Practice Address - Phone:952-469-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental