Provider Demographics
NPI:1588294110
Name:BEZEK FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:BEZEK FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BEZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MDM
Authorized Official - Phone:320-252-1085
Mailing Address - Street 1:1026 4TH ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-1371
Mailing Address - Country:US
Mailing Address - Phone:320-252-1085
Mailing Address - Fax:
Practice Address - Street 1:1026 4TH ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-1371
Practice Address - Country:US
Practice Address - Phone:320-252-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty