Provider Demographics
NPI:1669894986
Name:ORTHODONTIC CARE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:ORTHODONTIC CARE SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DOCTOR LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:KAUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-432-1103
Mailing Address - Street 1:14605 GLAZIER AVE. S,
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:952-432-1103
Mailing Address - Fax:952-891-8678
Practice Address - Street 1:7600 SUNWOOD DR. N.W.
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-786-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty