Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D12815 | MN |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS040239 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 56487 | MN |
NPI | 1144459587 |
---|---|
Provider Name | Kimberly C Bentjen |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 26/04/2015 |