Provider Demographics
NPI:1225193865
Name:DOROSCHAK, JOHN Z (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Z
Last Name:DOROSCHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:Z
Other - Last Name:DOROSCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7254 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014
Mailing Address - Country:US
Mailing Address - Phone:651-780-0340
Mailing Address - Fax:651-780-0340
Practice Address - Street 1:230 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413
Practice Address - Country:US
Practice Address - Phone:612-379-2300
Practice Address - Fax:612-379-0509
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND6547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist