Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 0401417229 | VA |
Y | 1223P0300X | Periodontist | S166 | MN |
NPI | 1053901330 |
---|---|
Provider Name | Artem Shurduk |
First Address | Rochester, MN 55901-3522 |
Second Address | Rochester, MN 55901-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 16/06/2021 |