=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770702714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOSSAI & KNUTSON, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 04/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2850 CURVE CREST BLVD W SUITE 200
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-439-9400
-----------------------------------------------------
Fax | 651-439-9402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2850 CURVE CREST BLVD W SUITE 200
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-439-9400
-----------------------------------------------------
Fax | 651-439-9402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DONNA KOBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-439-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12778
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------