Organization Name: | BROOKLYN BLVD. DENTAL |
NPI Number: | 1932373032 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM SAM KOTONIAS (DENTIST/OWNER) |
Mailing Address: | 5831 Brooklyn Blvd Brooklyn Center |
State: | MN US |
Postal Code: | 554292521 |
Phone Number: | 7635338669 |
Fax Number: | 7635338716 |
NPI Enumeration Date: | 04/18/2008 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 302R00000X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Managed Care Organizations |
Taxonomy Classification: | Health Maintenance Organization |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |