Healthcare Provider Details

I. General information

NPI: 1578687810
Provider Name (Legal Business Name): CHARLES EDWARD PRASKA DDS MS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 7TH AVE NW
ROCHESTER MN
55901-6298
US

IV. Provider business mailing address

15 7TH AVE NW
ROCHESTER MN
55901-6298
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-8844
  • Fax: 207-288-3865
Mailing address:
  • Phone: 207-288-8844
  • Fax: 207-288-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10257
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: