Provider Demographics
NPI:1619277043
Name:REKA KOERNER D.D.S.,P.A.
Entity Type:Organization
Organization Name:REKA KOERNER D.D.S.,P.A.
Other - Org Name:901 FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA REKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOERNER-VAJNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-501-6133
Mailing Address - Street 1:100 SEYMOUR AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3558
Mailing Address - Country:US
Mailing Address - Phone:612-501-6133
Mailing Address - Fax:
Practice Address - Street 1:901 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3609
Practice Address - Country:US
Practice Address - Phone:612-789-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty