Healthcare Provider Details

I. General information

NPI: 1275838187
Provider Name (Legal Business Name): BRIAN J KAJEWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 LAKELAND DR SE STE 1
WILLMAR MN
56201-4099
US

IV. Provider business mailing address

309 LAKELAND DR SE STE 1
WILLMAR MN
56201-4099
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-1075
  • Fax: 320-235-1075
Mailing address:
  • Phone: 320-235-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10360
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13347
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: