Healthcare Provider Details

I. General information

NPI: 1891418158
Provider Name (Legal Business Name): KAUSHIK MUKHERJEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15701 GROVE CIR N
MAPLE GROVE MN
55369-4490
US

IV. Provider business mailing address

2756 BRUNSWICK AVE S
MINNEAPOLIS MN
55416-1819
US

V. Phone/Fax

Practice location:
  • Phone: 763-233-3321
  • Fax:
Mailing address:
  • Phone: 213-332-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD15553
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: