Provider Demographics
NPI:1750499117
Name:KARP, JEFFREY (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KARP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1443
Mailing Address - Country:US
Mailing Address - Phone:612-659-4910
Mailing Address - Fax:612-659-4901
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1443
Practice Address - Country:US
Practice Address - Phone:612-659-4910
Practice Address - Fax:612-659-4901
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0517671223P0221X
MNFF501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595962Medicaid