Provider Demographics
NPI:1144366626
Name:EDC, P.L.L.C.
Entity type:Organization
Organization Name:EDC, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:JARMOLUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-441-2170
Mailing Address - Street 1:822 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1696
Mailing Address - Country:US
Mailing Address - Phone:763-441-2170
Mailing Address - Fax:763-441-9045
Practice Address - Street 1:822 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1696
Practice Address - Country:US
Practice Address - Phone:763-441-2170
Practice Address - Fax:763-441-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty