Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D8138 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 43848 | MN |
N | 208200000X | Surgeon | MD24022 | OR |
N | 208600000X | Surgeon | MD24022 | OR |
NPI | 1427023126 |
---|---|
Provider Name | Kevin Arce |
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 | 17/02/2006 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H47744 | (02) |