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General NPI Number Information
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NPI Number | 1003975061
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Entity Type | Individual
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Provider Name | KIRK ROLAND BAUMGARDNER DDS, PHD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1835 COUNTY ROAD C W
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City | ROSEVILLE
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State | MN
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Zip | 55113-1352
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Country | US
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Telephone | 651-746-0587
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Fax | 651-636-1118
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Provider Business Mailing Address
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Address Line | 716 HENSLOW AVE N
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City | OAKDALE
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State | MN
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Zip | 55128-5369
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Country | US
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Telephone | 651-702-1283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D11484
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License Number State | MN
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