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General NPI Number Information
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NPI Number | 1134532906
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Entity Type | Individual
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Provider Name | ROBERT VANDER BROEK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 822 38TH ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-6985
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Country | US
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Telephone | 507-289-3921
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Fax | 507-424-2943
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Provider Business Mailing Address
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Address Line | 2510 SUPERIOR DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-8348
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Country | US
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Telephone | 507-289-3921
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Fax | 507-424-2943
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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 | AC5385578-R103
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D13563
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License Number State | MN
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