Healthcare Provider Details

I. General information

NPI: 1730384074
Provider Name (Legal Business Name): ZUMBROTA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 S MAIN ST
ZUMBROTA MN
55992-1543
US

IV. Provider business mailing address

379 S MAIN ST
ZUMBROTA MN
55992-1543
US

V. Phone/Fax

Practice location:
  • Phone: 507-732-5346
  • Fax:
Mailing address:
  • Phone: 507-732-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12023
License Number StateMN

VIII. Authorized Official

Name: DR. RUPAM KADEMANI
Title or Position: DENTIST
Credential: DMD
Phone: 507-732-5346