1194826917 NPI number — METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA

Table of content: (NPI 1194826917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194826917 NPI number — METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA
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:
Provider Other Organization Name Type Code:
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:
1194826917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2855 CAMPUS DR
Provider Second Line Business Mailing Address:
STE 670
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55441-2649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-1234
Provider Business Mailing Address Fax Number:
763-520-1233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 CAMPUS DR
Provider Second Line Business Practice Location Address:
STE 670
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55441-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-1234
Provider Business Practice Location Address Fax Number:
763-520-1233
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORNER
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
763-257-0530

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  9698 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103025 . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 706006 . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109788 . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 471809682 . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8084585 . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2B177CU . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 706008 . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8084958 . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 190004291 . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4593HO . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 190007581 . This is a "DAVID CURTIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 373584714 . This is a "WILLIAM HOFFMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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