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General NPI Number Information
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NPI Number | 1174781843
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Entity Type | Organization
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Legal Business Name | GREGORY C PAPPENFUS DDS PA
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1545 NORTHWAY DRIVE SUITE 150
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-252-1300
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Fax | 320-252-0275
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Provider Business Mailing Address
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Address Line | 1545 NORTHWAY DRIVE SUITE 150
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. GREGORY C PAPPENFUS
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Credential | DDS PA
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Telephone | 320-252-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6587
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License Number State | MN
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