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General NPI Number Information
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NPI Number | 1992877088
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Entity Type | Organization
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Legal Business Name | FACIAL PLASTIC & RECONSTRUCTIVE SURGERY SPECIALISTS PA
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 7373 FRANCE AVE S SUITE 410
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City | EDINA
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State | MN
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Zip | 55435-4534
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Country | US
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Telephone | 952-844-0404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27015
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City | OMAHA
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State | NE
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Zip | 68127-0015
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Country | US
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Telephone | 402-393-9459
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Fax | 402-397-9895
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Authorized Official
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Title or Position | PHYSICIAN CODING & REIMBURSEMENT
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Name | JYL R DINVILLE
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Credential |
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Telephone | 402-397-5462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | 23875
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License Number State | MN
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