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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