# MINNESOTA ORAL AND FACIAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194363275
- **Authorized official:** DEEPAK KADEMANI DMD, MD (OWNER)
- **Authorized official phone:** (612) 568-0570

## Contact information

- **Practice address:** 2380 TROOP DR UNIT 202, SARTELL, MN 56377-4637
- **Practice address phone:** (320) 257-9555
- **Practice address fax:** (320) 257-9558
- **Mailing address:** 2380 TROOP DR UNIT 202, SARTELL, MN 56377-4637
- **Mailing address phone:** (320) 257-9555
- **Mailing address fax:** (320) 257-9558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |

## Other

- **Enumeration date:** 12/19/2019
- **Last updated:** 12/19/2019