MEDICARE: STEPHEN EDWARD GADIENT D.D.S.

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
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	D8284	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C01337	OTHER	MN	MEDICARE GROUP NUMBER
2	C01683	OTHER	MN	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1225001381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN EDWARD GADIENT D.D.S.

Provider Business Mailing Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 170
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-482-0065
Fax Number	:	651-482-6144

Provider Business Practice Location Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 170
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-482-0065
Fax Number	:	651-482-6144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	01/07/2008

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