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Organization
CUSTOM SMILES DENTISTRY, PLLC
Active
Organization
CUSTOM SMILES DENTISTRY, PLLC
Active
Other names
Custom Smiles Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAO CHUA VANG DDS (DENTIST)
(763) 390-8995
Entity
Organization
Contact information
Practice address
2258 BUNKER LAKE BLVD NW, ANDOVER, MN 55304-3900
(763) 390-8995
(763) 390-8999
Mailing address
2258 BUNKER LAKE BLVD NW, ANDOVER, MN 55304-3900
(763) 390-8995
(763) 390-8999
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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