Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5084 | MN |
NPI | 1073529103 |
---|---|
Provider Name | Dr. David Wayne Zemke |
First Address | Minneapolis, MN 55422-2938 |
Second Address | Minneapolis, MN 55422-2938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |