Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D13996 | MN |
NPI | 1003306952 |
---|---|
Provider Name | Dr. Kyle Jon Rasmussen |
First Address | Saint Peter, MN 56082-0448 |
Second Address | Saint Peter, MN 56082-2055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 16/05/2018 |