Provider Demographics
NPI:1174913339
Name:TODAY'S DENTAL ST.CLOUD SC
Entity type:Organization
Organization Name:TODAY'S DENTAL ST.CLOUD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-774-2557
Mailing Address - Street 1:4128 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3704
Mailing Address - Country:US
Mailing Address - Phone:320-774-2557
Mailing Address - Fax:763-710-9968
Practice Address - Street 1:7960 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2722
Practice Address - Country:US
Practice Address - Phone:763-710-9937
Practice Address - Fax:763-710-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12960305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service