Provider Demographics
NPI:1932117769
Name:PELKE, MICHAEL MANFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MANFRED
Last Name:PELKE
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 1:215 RADIO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55125-5815
Mailing Address - Country:US
Mailing Address - Phone:651-739-7910
Mailing Address - Fax:651-739-0611
Practice Address - Street 1:215 RADIO DR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-5815
Practice Address - Country:US
Practice Address - Phone:651-739-7910
Practice Address - Fax:651-739-0611
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice