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Organization

PL DENTAL SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PHONG VINH LY DDS (OWNER)
(763) 317-1168
Entity
Organization

Contact information

Practice address
12628 FREMONT AVE, ZIMMERMAN, MN 55398-9735
(833) 217-5959
Mailing address
9920 FOLEY BLVD NW STE 110, COON RAPIDS, MN 55433-5216
(633) 171-1667
(763) 317-1167

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790131791
MN
Enumeration date
03/16/2022
Last updated
05/22/2024
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