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General NPI Number Information
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NPI Number | 1518295567
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Entity Type | Organization
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Legal Business Name | VIRGINIA-GILBERT FAMILY DENTAL P.A
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 612-13TH. ST. SO.
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-741-0405
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Fax | 218-741-1445
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Provider Business Mailing Address
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Address Line | 612-13TH. ST. SO.
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-741-0405
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Fax | 218-741-1445
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Authorized Official
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Title or Position | SECRETARY - DENTIST
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Name | DR. JOHN T. ZUPANCIC
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Credential | D.D.S.
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Telephone | 218-741-0405
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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 |
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License Number State |
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