Healthcare Provider Details

I. General information

NPI: 1225100811
Provider Name (Legal Business Name): POSTHUMUS & BIORN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 CENTRAL AVE E
SAINT MICHAEL MN
55376-0279
US

IV. Provider business mailing address

PO BOX 279
SAINT MICHAEL MN
55376-0279
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-2040
  • Fax:
Mailing address:
  • Phone: 763-497-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. DIRK POSTHUMUS
Title or Position: PRESIDENT
Credential:
Phone: 763-497-2040