Provider Demographics
NPI:1366518805
Name:KOERNER-VAJNA, REKA MARIA
Entity type:Individual
Prefix:DR
First Name:REKA
Middle Name:MARIA
Last Name:KOERNER-VAJNA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:REKA
Other - Middle Name:
Other - Last Name:KOERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1800 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4528
Mailing Address - Country:US
Mailing Address - Phone:612-789-9444
Mailing Address - Fax:
Practice Address - Street 1:1800 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4528
Practice Address - Country:US
Practice Address - Phone:612-789-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice