Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D13718 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | 29839 | MN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 68357 | MN |
NPI | 1407203417 |
---|---|
Provider Name | Dr. Daniel Scott Kirk |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2016 |
Last Update Date | 22/10/2020 |