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NPI Code Detail

MEDICARE: TANU DHOOPAR ADT

MEDICARE:   TANU  DHOOPAR  ADT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1125K00000XAdvanced Practice Dental TherapistDT26MN

General Provider Information

NPI Number : 1124483656
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANU DHOOPAR ADT
Provider Business Mailing Address
First Line : 10374 QUAIL CIR N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-5417
Country : US
Telephone Number : 763-360-8991
Fax Number :
Provider Business Practice Location Address
First Line : 3152 MINNEHAHA AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1934
Country : US
Telephone Number : 612-332-4973
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2015
Last Update Date : 12/29/2015

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Directions to “ TANU DHOOPAR ADT” Practice Location

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