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General NPI Number Information
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NPI Number | 1275892218
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Entity Type | Organization
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Legal Business Name | EDINA ORAL AND MAXILLOFACIAL SURGERY, P.A.
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S SUITE 690
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-925-2525
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Fax | 952-925-2529
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Provider Business Mailing Address
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Address Line | 6545 FRANCE AVE S SUITE 690
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-925-2525
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Fax | 952-925-2529
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | PAUL C TOMPACH
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Credential |
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Telephone | 952-925-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D11128
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License Number State | MN
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