Provider Demographics
NPI:1538220207
Name:ABERDEEN DENTAL ASSOCIATES
Entity type:Organization
Organization Name:ABERDEEN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-786-4280
Mailing Address - Street 1:11800 ABERDEEN ST NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4808
Mailing Address - Country:US
Mailing Address - Phone:763-786-4280
Mailing Address - Fax:763-754-6226
Practice Address - Street 1:11800 ABERDEEN ST NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4808
Practice Address - Country:US
Practice Address - Phone:763-786-4280
Practice Address - Fax:763-754-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty