Healthcare Provider Details

I. General information

NPI: 1235293564
Provider Name (Legal Business Name): THOMAS ERIK NEAFUS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 VILLAGE CENTER DR SUITE 150
NORTH OAKS MN
55127-3019
US

IV. Provider business mailing address

12 WILDFLOWER PL
NORTH OAKS MN
55127-6221
US

V. Phone/Fax

Practice location:
  • Phone: 651-481-8443
  • Fax:
Mailing address:
  • Phone: 651-340-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD11136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: