Organization
AL SHIFA DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NASIR LATIF (PRESIDENT)
(612) 481-1976
Entity
Organization
Contact information
Practice address
12936 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 559-3400
(763) 559-3900
Mailing address
12936 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 559-3400
(763) 559-3900
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D12215
MN
Other
Enumeration date
06/19/2010
Last updated
06/19/2010
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