| Custom Smiles Dentistry, Pllc | |
|
2258 Bunker Lake Blvd Nw Andover MN 55304-3900 | |
| (763) 390-8995 | |
| (763) 390-8999 |
| Full Name | Custom Smiles Dentistry, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2258 Bunker Lake Blvd Nw, Andover, Minnesota |
| Authorized Official Name and Position | Pao Chua Vang (DENTIST) |
| Authorized Official Contact | 7633908995 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Smiles Dentistry, Pllc 2258 Bunker Lake Blvd Nw Andover MN 55304-3900 Ph: (763) 390-8995 | Custom Smiles Dentistry, Pllc 2258 Bunker Lake Blvd Nw Andover MN 55304-3900 Ph: (763) 390-8995 |
| NPI Number | 1528678497 |
|---|---|
| Provider Enumeration Date | 08/05/2020 |
| Last Update Date | 08/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528678497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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