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General NPI Number Information
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NPI Number | 1225193865
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Entity Type | Individual
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Provider Name | JOHN Z DOROSCHAK DDS
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 230 BROADWAY ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55413
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Country | US
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Telephone | 612-379-2300
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Fax | 612-379-0509
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Provider Business Mailing Address
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Address Line | 7254 STAGECOACH TRL
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City | LINO LAKES
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State | MN
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Zip | 55014
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Country | US
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Telephone | 651-780-0340
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Fax | 651-780-0340
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D6547
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License Number State | MN
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