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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