Healthcare Provider Details

I. General information

NPI: 1356554125
Provider Name (Legal Business Name): ROBERT WEINRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 2ND ST SW
ROCHESTER MN
55902-2983
US

IV. Provider business mailing address

1344 CAMELBACK CT NE
ROCHESTER MN
55906-8900
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6378
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: