Individual
DR. THOMAS JEROME ZYVOLOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11475 ROBINSON DR NW, COON RAPIDS, MN 55433
(763) 754-0041
(763) 754-4506
Mailing address
PO BOX 1309, MAIL CODE 21113A, MINNEAPOLIS, MN 55440-1309
(952) 883-5151
(952) 883-5160
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10880
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
912323700
—
MN
Enumeration date
08/31/2006
Last updated
08/04/2008
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