Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D13469 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | D13469 | MN |
NPI | 1427464593 |
---|---|
Provider Name | Dr. Richard Zavada |
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 | 09/07/2014 |
Last Update Date | 29/11/2017 |