Provider Demographics
NPI:1235944190
Name:911 DENTAL GROUP
Entity type:Organization
Organization Name:911 DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NANA
Authorized Official - Middle Name:YAW
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:262-900-2191
Mailing Address - Street 1:810 THORNTON ST SE APT 1104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3657
Mailing Address - Country:US
Mailing Address - Phone:773-640-1715
Mailing Address - Fax:
Practice Address - Street 1:400 LAKE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1020
Practice Address - Country:US
Practice Address - Phone:262-900-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental