Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10388 | MN |
NPI | 1013026053 |
---|---|
Provider Name | Dr. Andrew Mark Doroschak |
First Address | Burnsville, MN 55337-6734 |
Second Address | Burnsville, MN 55337-6734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |