Provider Demographics
NPI:1780902080
Name:ROBBINSDALE DENTAL PLLC
Entity type:Organization
Organization Name:ROBBINSDALE DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KADEMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:763-537-5123
Mailing Address - Street 1:2700 CAPRIOLE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9494
Mailing Address - Country:US
Mailing Address - Phone:612-865-5185
Mailing Address - Fax:
Practice Address - Street 1:4125 LAKELAND AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1852
Practice Address - Country:US
Practice Address - Phone:763-537-5123
Practice Address - Fax:763-533-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty