Provider Demographics
NPI:1952741290
Name:ABRAMOWSKI, DEREK DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DANIEL
Last Name:ABRAMOWSKI
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 1:12027 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4526
Mailing Address - Country:US
Mailing Address - Phone:763-421-7900
Mailing Address - Fax:763-421-7916
Practice Address - Street 1:201 SANDBERG RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8906
Practice Address - Country:US
Practice Address - Phone:763-295-5400
Practice Address - Fax:763-295-1785
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist