| Smisek Family Dentistry P.a. | |
|
501 Tanglewood Dr Shoreview MN 55126-2016 | |
| (651) 483-6747 | |
| (651) 483-1863 |
| Full Name | Smisek Family Dentistry P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 501 Tanglewood Dr, Shoreview, Minnesota |
| Authorized Official Name and Position | Gary Ralph Smisek (PRESIDENT SMISEK FAMILY DENTISTRY) |
| Authorized Official Contact | 6514836747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smisek Family Dentistry P.a. 501 Tanglewood Dr Shoreview MN 55126-2016 Ph: (651) 483-6747 | Smisek Family Dentistry P.a. 501 Tanglewood Dr Shoreview MN 55126-2016 Ph: (651) 483-6747 |
| NPI Number | 1457570194 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 07/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457570194 | NPI | - | NPPES |
| 41-124-3604 | Other | FEDERAL ID. NUMBER | |
| 66340-47 | Other | MN | STATE MN ID NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 7909 (Minnesota) | Secondary |
| 1223G0001X | Dentist - General Practice | 9783 (Minnesota) | Primary |
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