MEDICARE: LUBOMIR SERAFIMOV DDS , P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11864	MN

General Provider Information

NPI Number	:	1073610259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUBOMIR SERAFIMOV DDS , P.A.

Provider Business Mailing Address
First Line	:	250 WENTWORTH AVE E
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-3507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 WENTWORTH AVE E
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-3507
Country	:	US
Telephone Number	:	651-455-1601
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUBOMIR SERAFIMOV
Credential	:
Telephone Number	:	651-455-1601

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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