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Organization
CHASKA PEDIATRIC DENTISTRY, P.A.
Active
Organization
CHASKA PEDIATRIC DENTISTRY, P.A.
Active
Other names
Tailwind Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR STEPHENS D.D.S (OWNER/PRESIDENT)
(952) 475-3135
Entity
Organization
Contact information
Practice address
111 HUNDERTMARK RD, SUITE 304N, CHASKA, MN 55318-4551
(952) 475-3135
Mailing address
250 CENTRAL AVE N, SUITE 113, WAYZATA, MN 55391-1206
(952) 475-3135
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D12818
MN
Other
Enumeration date
01/17/2014
Last updated
01/17/2014
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