Healthcare Provider Details

I. General information

NPI: 1699745323
Provider Name (Legal Business Name): PAUL CHRISTOPHER TOMPACH D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELAWARE STREET SE 7-174 MOOS HEALTH SCIENCES TOWER
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

515 DELAWARE STREET SE 7-174 MOOS HEALTH SCIENCES TOWER
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-301-2233
  • Fax: 612-625-2669
Mailing address:
  • Phone: 612-301-2233
  • Fax: 612-625-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD11128
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD11128
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: