Provider Demographics
NPI:1962469759
Name:RAJEK, EDGAR DAVID JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:DAVID
Last Name:RAJEK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7493 147TH ST W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4505
Mailing Address - Country:US
Mailing Address - Phone:952-432-0010
Mailing Address - Fax:952-432-0011
Practice Address - Street 1:7493 147TH ST W
Practice Address - Street 2:SUITE 105
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4505
Practice Address - Country:US
Practice Address - Phone:952-432-0010
Practice Address - Fax:952-432-0011
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN80371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics