Provider Demographics
NPI:1770702714
Name:GOSSAI & KNUTSON, DDS, PA
Entity type:Organization
Organization Name:GOSSAI & KNUTSON, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-439-9400
Mailing Address - Street 1:2850 CURVE CREST BLVD W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4039
Mailing Address - Country:US
Mailing Address - Phone:651-439-9400
Mailing Address - Fax:651-439-9402
Practice Address - Street 1:2850 CURVE CREST BLVD W
Practice Address - Street 2:SUITE 200
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4039
Practice Address - Country:US
Practice Address - Phone:651-439-9400
Practice Address - Fax:651-439-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831419209OtherNPI GOSSAI
MN18386OtherH. PARTNER ID - FLODIN
1477692903OtherNPI KNUTSON
MN1184616005OtherNPI - FLODIN
MN9909Medicaid
MN293218100Medicaid
MN1477692903Medicaid
MN1831419209Medicaid