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General NPI Number Information
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NPI Number | 1588296024
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Entity Type | Individual
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Provider Name | ABHINA GAUTAM MS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 2680 E SNELLING SER DR 100
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 612-662-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E GRANT ST APT 1706
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-1476
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Country | US
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Telephone | 352-214-4330
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DPRM2096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | S215
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License Number State | MN
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