=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588965420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFORDABLE DENTURES - ROCHESTER, MN, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2010
-----------------------------------------------------
Last Update Date | 11/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3434 55TH ST NW STE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-5926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-529-9442
-----------------------------------------------------
Fax | 507-529-9444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3434 55TH ST NW STE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-5926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-529-9442
-----------------------------------------------------
Fax | 507-529-9444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID BURRICHTER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 507-529-9442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------