Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8404 | MN |
NPI | 1013040765 |
---|---|
Provider Name | Dr. Robert Lloyd Juhnke |
First Address | St Paul, MN 55105 |
Second Address | St Paul, MN 55105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 22/09/2011 |