Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 46570 | MN |
NPI | 1356327431 |
---|---|
Provider Name | Deepak Kademani |
First Address | Sartell, MN 56377-4637 |
Second Address | Sartell, MN 56377-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 29/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
375453700 | (05) | MN |
I00256 | (02) |