Provider Demographics
NPI:1871228346
Name:BUFFALO FAMILY DENTISTRY
Entity type:Organization
Organization Name:BUFFALO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-682-6885
Mailing Address - Street 1:106 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2956
Mailing Address - Country:US
Mailing Address - Phone:763-682-6885
Mailing Address - Fax:763-682-4534
Practice Address - Street 1:106 CENTER DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2956
Practice Address - Country:US
Practice Address - Phone:763-682-6885
Practice Address - Fax:763-682-4534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUFFALO FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty