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Contact Information

GREAT LAKES CHILDRENS DENTAL CARE PA
2710 PIEDMONT AVENUE
DULUTH, MN55811
 Phone: 218-525-5100
 Fax: 218-722-3883
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
 

Pediatric Dentistry

1223P0221X
Indicates primary specialty

NPI Profile & details for GREAT LAKES CHILDRENS DENTAL CARE PA

NPI Number 1790795821
LBN Legal business name GREAT LAKES CHILDRENS DENTAL CARE PA
Authorized official RAMI GUIRGUIS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/09/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
MN License # D10919
MN License # D11559
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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