Healthcare Provider Details

I. General information

NPI: 1265728299
Provider Name (Legal Business Name): TUDOR I. STIHARU DMD, FRCD(C)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14344 BURNHAVEN DR
BURNSVILLE MN
55306-4928
US

IV. Provider business mailing address

14344 BURNHAVEN DR
BURNSVILLE MN
55306-4928
US

V. Phone/Fax

Practice location:
  • Phone: 612-638-1238
  • Fax: 952-898-4109
Mailing address:
  • Phone: 612-638-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD13624
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: