Provider Demographics
NPI:1528508348
Name:CARVER DENTAL PA
Entity type:Organization
Organization Name:CARVER DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-839-0873
Mailing Address - Street 1:4725 DAHLGREN RD
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-2201
Mailing Address - Country:US
Mailing Address - Phone:952-960-9060
Mailing Address - Fax:952-960-9066
Practice Address - Street 1:4725 DAHLGREN RD
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MN
Practice Address - Zip Code:55315-2201
Practice Address - Country:US
Practice Address - Phone:952-960-9060
Practice Address - Fax:952-960-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12924261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental