Provider Demographics
NPI:1992890917
Name:ADVANCED DERMATOLOGY & COSMETIC INSTITUTE P.A.
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY & COSMETIC INSTITUTE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-915-6000
Mailing Address - Street 1:6525 BARRIE RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2305
Mailing Address - Country:US
Mailing Address - Phone:952-915-6000
Mailing Address - Fax:952-915-6100
Practice Address - Street 1:6525 BARRIE RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2305
Practice Address - Country:US
Practice Address - Phone:952-915-6000
Practice Address - Fax:952-915-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN28680207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty