Provider Demographics
NPI:1194363275
Name:MINNESOTA ORAL AND FACIAL SURGERY PLLC
Entity Type:Organization
Organization Name:MINNESOTA ORAL AND FACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KADEMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:612-568-0570
Mailing Address - Street 1:2380 TROOP DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4637
Mailing Address - Country:US
Mailing Address - Phone:320-257-9555
Mailing Address - Fax:320-257-9558
Practice Address - Street 1:2380 TROOP DR UNIT 202
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4637
Practice Address - Country:US
Practice Address - Phone:320-257-9555
Practice Address - Fax:320-257-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty