Healthcare Provider Details

I. General information

NPI: 1427548031
Provider Name (Legal Business Name): KIRK V. DENTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 12TH ST N STE 202
SAINT CLOUD MN
56303-2253
US

IV. Provider business mailing address

656 158TH AVE NW
ANDOVER MN
55304-2788
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax:
Mailing address:
  • Phone: 817-271-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberPENDING
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: