Provider Demographics
NPI:1922403021
Name:DADUL, TENZIN (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:TENZIN
Middle Name:
Last Name:DADUL
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 BENJAMIN ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5855
Mailing Address - Country:US
Mailing Address - Phone:612-707-5104
Mailing Address - Fax:
Practice Address - Street 1:5921 BENJAMIN ST NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5855
Practice Address - Country:US
Practice Address - Phone:612-707-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFL47122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology