Provider Demographics
NPI:1194826917
Name:METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA
Entity type:Organization
Organization Name:METROPOLITAN ORAL AND MAXILLOFACIAL SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-257-0530
Mailing Address - Street 1:2855 CAMPUS DR
Mailing Address - Street 2:STE 670
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2649
Mailing Address - Country:US
Mailing Address - Phone:763-520-1234
Mailing Address - Fax:763-520-1233
Practice Address - Street 1:2855 CAMPUS DR
Practice Address - Street 2:STE 670
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2649
Practice Address - Country:US
Practice Address - Phone:763-520-1234
Practice Address - Fax:763-520-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103025OtherDAVID CURTIS
MN706006OtherWILLIAM HOFFMANN
MN109788OtherWILLIAM HOFFMANN
MN471809682OtherDAVID CURTIS
MN8084585OtherDAVID CURTIS
MN2B177CUOtherDAVID CURTIS
MN706008OtherDAVID CURTIS
MN8084958OtherWILLIAM HOFFMANN
MN190004291OtherWILLIAM HOFFMANN
MN4593HOOtherWILLIAM HOFFMANN
MN190007581OtherDAVID CURTIS
MN373584714OtherWILLIAM HOFFMANN
MN190004291OtherWILLIAM HOFFMANN
MN190007581OtherDAVID CURTIS
MN471809682OtherDAVID CURTIS
MN8084585OtherDAVID CURTIS
MN373584714OtherWILLIAM HOFFMANN
MN850000059Medicare ID - Type UnspecifiedS. LYLE ZUCK
MN850000061Medicare ID - Type UnspecifiedDAVID CURTIS
MN850000060Medicare ID - Type UnspecifiedPAUL TOMPACH
MNC01183Medicare PIN