Provider Demographics
NPI:1538533989
Name:DEREK ABRAMOWSKI DDS
Entity type:Organization
Organization Name:DEREK ABRAMOWSKI DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ABRAMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-229-2613
Mailing Address - Street 1:201 SANDBERG RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8906
Mailing Address - Country:US
Mailing Address - Phone:763-295-5400
Mailing Address - Fax:763-295-1785
Practice Address - Street 1:201 SANDBERG RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8906
Practice Address - Country:US
Practice Address - Phone:763-295-5400
Practice Address - Fax:763-295-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13279261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental