Provider Demographics
NPI:1245075977
Name:O'BORSKY, DYLAN MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL
Last Name:O'BORSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-5636
Mailing Address - Country:US
Mailing Address - Phone:763-478-7701
Mailing Address - Fax:
Practice Address - Street 1:16991 198TH AVE NW
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4927
Practice Address - Country:US
Practice Address - Phone:763-263-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND151171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice