Provider Demographics
NPI:1588307011
Name:BLISS FAMILY DENTAL JULIE KONOP, DDS, PLLC
Entity type:Organization
Organization Name:BLISS FAMILY DENTAL JULIE KONOP, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-447-3777
Mailing Address - Street 1:4792 DAKOTA ST SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1883
Mailing Address - Country:US
Mailing Address - Phone:952-447-3777
Mailing Address - Fax:952-447-2877
Practice Address - Street 1:4792 DAKOTA ST SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1883
Practice Address - Country:US
Practice Address - Phone:952-447-3777
Practice Address - Fax:952-447-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700993284OtherTYPE 1