Healthcare Provider Details

I. General information

NPI: 1770655425
Provider Name (Legal Business Name): DAVID PATRICK PAZANDAK DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 260
SAINT CLOUD MN
56303-4555
US

IV. Provider business mailing address

1555 NORTHWAY DR STE 260
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-2570
  • Fax: 320-252-0214
Mailing address:
  • Phone: 320-252-2570
  • Fax: 320-252-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7968
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: