Individual
JUDE FAYEZ ITANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BDS
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
PO BOX 860912, MINNEAPOLIS, MN 55486-0912
(072) 842-5115
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
S232
MN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S232
MN
Other
Enumeration date
02/14/2021
Last updated
03/31/2026
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