Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11000 | MN |
NPI | 1003975137 |
---|---|
Provider Name | Daniel F Pink |
First Address | Forest Lake, MN 55025 |
Second Address | Forest Lake, MN 55025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |