MEDICARE: KEVIN J TORBENSON 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	122300000X	Dentist	8804	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8804	OTHER	MN	LICENSE NUMBER

General Provider Information

NPI Number	:	1710061163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN J TORBENSON D.D.S.

Provider Business Mailing Address
First Line	:	46675 CAPE HORN RD
Second Line	:
City	:	CLEVELAND
State	:	MN
Zip	:	56017-4537
Country	:	US
Telephone Number	:	507-934-7392
Fax Number	:	507-345-5723

Provider Business Practice Location Address
First Line	:	608 E MADISON AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-6112
Country	:	US
Telephone Number	:	507-345-1284
Fax Number	:	507-345-5723

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/07/2023

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