Provider Demographics
NPI:1508238528
Name:TUPALO, PC
Entity Type:Organization
Organization Name:TUPALO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:KOTTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-224-1192
Mailing Address - Street 1:332 MINNESOTA ST
Mailing Address - Street 2:SUITE E 720
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1314
Mailing Address - Country:US
Mailing Address - Phone:651-224-1192
Mailing Address - Fax:
Practice Address - Street 1:332 MINNESOTA ST
Practice Address - Street 2:SUITE E 720
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1314
Practice Address - Country:US
Practice Address - Phone:651-224-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11602261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental