Healthcare Provider Details

I. General information

NPI: 1558586248
Provider Name (Legal Business Name): M ICHAEL FRANK CONTARDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 2ND AVE NW
SAINT JOSEPH MN
56374-4106
US

IV. Provider business mailing address

26 2ND AVE NW PO BOX 728
SAINT JOSEPH MN
56374-4106
US

V. Phone/Fax

Practice location:
  • Phone: 132-036-3446
  • Fax:
Mailing address:
  • Phone: 132-036-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8765
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: