Provider Demographics
NPI:1982789731
Name:DESIMONE, DAVID ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALBERT
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12725 43RD ST NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-4900
Mailing Address - Country:US
Mailing Address - Phone:763-497-2367
Mailing Address - Fax:763-497-8171
Practice Address - Street 1:12725 43RD ST NE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-4900
Practice Address - Country:US
Practice Address - Phone:763-497-2367
Practice Address - Fax:763-497-8171
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN84241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice