Provider Demographics
NPI:1700589264
Name:ADVANCED RECONSTRUCTIVE DENTISTRY PLLC
Entity type:Organization
Organization Name:ADVANCED RECONSTRUCTIVE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:DELIMA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS FACP
Authorized Official - Phone:952-922-5326
Mailing Address - Street 1:6545 FRANCE AVE S STE 680
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2127
Mailing Address - Country:US
Mailing Address - Phone:952-922-5326
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE 680
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2127
Practice Address - Country:US
Practice Address - Phone:952-922-5326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty