Provider Demographics
NPI:1710061163
Name:TORBENSON, KEVIN J (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:TORBENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46675 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MN
Mailing Address - Zip Code:56017-4537
Mailing Address - Country:US
Mailing Address - Phone:507-934-7392
Mailing Address - Fax:507-345-5723
Practice Address - Street 1:608 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6112
Practice Address - Country:US
Practice Address - Phone:507-345-1284
Practice Address - Fax:507-345-5723
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8804OtherLICENSE NUMBER
MNAT-8688775OtherDEA
MNAT-8688775OtherDEA