| Organization Name: | CHASKA PEDIATRIC DENTISTRY, P.A. |
| NPI Number: | 1063834588 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAYLOR STEPHENS (OWNER/PRESIDENT) |
| Mailing Address: | 111 Hundertmark Rd Suite 304n Chaska |
| State: | MN US |
| Postal Code: | 553184551 |
| Phone Number: | 9524753135 |
| Fax Number: | |
| NPI Enumeration Date: | 01/17/2014 |
| NPI Last Update Date: | 01/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D12818 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |