Individual
DR. PRASAD ANIL BASTODKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7136 UNIVERSITY AVE NE, FRIDLEY, MN 55432-3100
(763) 574-1639
Mailing address
7136 UNIVERSITY AVE NE, FRIDLEY, MN 55432-3100
(763) 574-1639
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11738
MN
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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