Healthcare Provider Details

I. General information

NPI: 1568067213
Provider Name (Legal Business Name): ZUMBRO VALLEY ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 SUPERIOR DR NW
ROCHESTER MN
55901-8533
US

IV. Provider business mailing address

2659 SUPERIOR DR NW
ROCHESTER MN
55901-8533
US

V. Phone/Fax

Practice location:
  • Phone: 507-281-1295
  • Fax:
Mailing address:
  • Phone: 507-281-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL STEPHENSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 507-281-1295