Provider Demographics
NPI:1992752117
Name:DERMATOLOGY SPECIALISTS, PA
Entity type:Organization
Organization Name:DERMATOLOGY SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:IX
Authorized Official - Credentials:MD
Authorized Official - Phone:952-920-3808
Mailing Address - Street 1:3316 W 66TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2506
Mailing Address - Country:US
Mailing Address - Phone:952-920-3808
Mailing Address - Fax:952-920-8899
Practice Address - Street 1:3316 W 66TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2506
Practice Address - Country:US
Practice Address - Phone:952-920-3808
Practice Address - Fax:952-920-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty