Provider Demographics
NPI:1770655425
Name:PAZANDAK, DAVID PATRICK (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PATRICK
Last Name:PAZANDAK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1555 NORTHWAY DR
Mailing Address - Street 2:STE 260
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-252-2570
Mailing Address - Fax:320-252-0214
Practice Address - Street 1:1555 NORTHWAY DR
Practice Address - Street 2:STE 260
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4555
Practice Address - Country:US
Practice Address - Phone:320-252-2570
Practice Address - Fax:320-252-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN79681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics