1093828261 NPI number — LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS

Table of content: (NPI 1093828261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093828261 NPI number — LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOWRY HILL DENTAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093828261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1516 W LAKE ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55408-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-822-1484
Provider Business Mailing Address Fax Number:
612-822-9458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 W LAKE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55408-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-822-1484
Provider Business Practice Location Address Fax Number:
612-822-9458
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PROCHASKA
Authorized Official First Name:
PATICK
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
612-823-7942

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D9045 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: D9138 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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