Healthcare Provider Details

I. General information

NPI: 1356409577
Provider Name (Legal Business Name): DR. BRUCE ROBERT KARG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OAK AVENUE NORTH
ANNANDALE MN
55302
US

IV. Provider business mailing address

PO BOX 649 18 OAK AVENUE NORTH
ANNANDALE MN
55302
US

V. Phone/Fax

Practice location:
  • Phone: 320-274-5411
  • Fax:
Mailing address:
  • Phone: 320-274-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9667
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: