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Organization
SMISEK FAMILY DENTISTRY P.A.
Active
Organization
SMISEK FAMILY DENTISTRY P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY RALPH SMISEK DDS (PRESIDENT SMISEK FAMILY DENTISTRY)
(651) 483-6747
Entity
Organization
Contact information
Practice address
501 TANGLEWOOD DR, SHOREVIEW, MN 55126-2016
(651) 483-6747
(651) 483-1863
Mailing address
501 TANGLEWOOD DR, SHOREVIEW, MN 55126-2016
(651) 483-6747
(651) 483-1863
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7909
MN
1223G0001X
General Practice Dentistry
Primary
9783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41-124-3604
FEDERAL ID. NUMBER
—
01
—
66340-47
STATE MN ID NUMBER
MN
Enumeration date
04/24/2007
Last updated
07/17/2008
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