Organization
URGENT CARE DENTAL PLLC
Active
Other names
Crystal Clean Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MUKTAR A FARAH (CEO)
(612) 707-3768
Entity
Organization
Contact information
Practice address
331 WILLOW BND APT 705, CRYSTAL, MN 55428-3969
(612) 707-3768
Mailing address
1320 W LAKE ST APT 521, MINNEAPOLIS, MN 55408-4987
(612) 707-3768
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/08/2021
Last updated
03/08/2021
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