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General NPI Number Information
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NPI Number | 1912920059
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Entity Type | Organization
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Legal Business Name | MADISON AVENUE FAMILY DENTAL CENTER, LTD
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 608 E MADISON AVE
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City | MANKATO
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State | MN
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Zip | 56001-6112
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Country | US
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Telephone | 507-345-1284
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Fax | 507-345-5723
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Provider Business Mailing Address
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Address Line | 608 E MADISON AVE
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City | MANKATO
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State | MN
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Zip | 56001-6112
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Country | US
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Telephone | 507-345-1284
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Fax | 507-345-5723
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. KEVIN J. TORBENSON
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Credential | D.D.S.
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Telephone | 507-345-1284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11277
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8804
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License Number State | MN
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