Healthcare Provider Details

I. General information

NPI: 1801951512
Provider Name (Legal Business Name): DR. PAUL K ZOLLINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E COUNTY RD E SUITE 185
VADNAIS HEIGHTS MN
55127-7197
US

IV. Provider business mailing address

925 E COUNTY RD E SUITE 185
VADNAIS HEIGHTS MN
55127-7197
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-1122
  • Fax: 651-766-2557
Mailing address:
  • Phone: 651-482-1122
  • Fax: 651-766-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9142
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: