Healthcare Provider Details

I. General information

NPI: 1972362457
Provider Name (Legal Business Name): MICHAEL KORLESKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BIRCH ST N STE 114
CAMBRIDGE MN
55008-1507
US

IV. Provider business mailing address

140 BIRCH ST N STE 114
CAMBRIDGE MN
55008-1507
US

V. Phone/Fax

Practice location:
  • Phone: 763-347-4399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: