Provider Demographics
NPI:1417210576
Name:GREGORY H. KAAKE, D.D.S. P.A.
Entity Type:Organization
Organization Name:GREGORY H. KAAKE, D.D.S. P.A.
Other - Org Name:MILLER HILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-722-1070
Mailing Address - Street 1:1832 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1811
Mailing Address - Country:US
Mailing Address - Phone:218-722-1070
Mailing Address - Fax:218-733-0959
Practice Address - Street 1:1832 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1811
Practice Address - Country:US
Practice Address - Phone:218-722-1070
Practice Address - Fax:218-733-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8798261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental