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General NPI Number Information
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NPI Number | 1053301960
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Entity Type | Individual
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Provider Name | PAUL FRANKLIN KIRKEGAARD JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2278 COMO AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1740
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Country | US
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Telephone | 651-644-9216
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Fax | 651-645-8097
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Provider Business Mailing Address
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Address Line | 2278 COMO AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1740
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Country | US
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Telephone | 651-644-9216
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Fax | 651-645-8097
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9453
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License Number State | MN
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