Healthcare Provider Details

I. General information

NPI: 1952741290
Provider Name (Legal Business Name): DEREK DANIEL ABRAMOWSKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SANDBERG RD
MONTICELLO MN
55362-8906
US

IV. Provider business mailing address

12027 BUSINESS PARK BLVD N
CHAMPLIN MN
55316-4526
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-5400
  • Fax: 763-295-1785
Mailing address:
  • Phone: 763-421-7900
  • Fax: 763-421-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13279
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: