MEDICARE: DR. BENJAMIN TOBIAS PLISKA DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D12471	MN

General Provider Information

NPI Number	:	1881886919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN TOBIAS PLISKA DDS, MS

Provider Business Mailing Address
First Line	:	1314 MARQUETTE AVE APT 1303
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-4112
Country	:	US
Telephone Number	:	612-986-5539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 MARQUETTE AVE APT 1303
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-4112
Country	:	US
Telephone Number	:	612-986-5539
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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