1144307232 NPI number — SKYWAY DENTAL CLINIC, P.L.L.C.

Table of content: (NPI 1144307232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144307232 NPI number — SKYWAY DENTAL CLINIC, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKYWAY DENTAL CLINIC, P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144307232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 2ND AVE S, SUITE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-338-4122
Provider Business Mailing Address Fax Number:
612-338-1713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 2ND AVE S.
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-338-4122
Provider Business Practice Location Address Fax Number:
612-338-1713
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
CRAVEN
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
612-338-4122

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: D9274 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com