MEDICARE: MITCHELL HABERMAN DDS

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	1223G0001X	General Practice Dentistry	40782	MN

General Provider Information

NPI Number	:	1710723234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL HABERMAN DDS

Provider Business Mailing Address
First Line	:	200 UNIVERSITY AVE SE UNIT 1405
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2150
Country	:	US
Telephone Number	:	507-676-4997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 LEXINGTON AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-5867
Country	:	US
Telephone Number	:	507-676-4997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	09/19/2025

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