Brodersen, Tara Vonne
Brodersen, Tara Vonne is an sole proprietor health care provider with primary practice located at 200 University Ave E , Saint Paul MN 55101-2507. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Brodersen, Tara Vonne can be contacted via phone (651) 291-2848.Contact Information
Primary practice address
200 University Ave E
Saint Paul MN 55101-2507
Phone: (651) 291-2848
Fax: (651) 602-6885
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D11913 | Minnesota |
Profile Details
| NPI number | 1336138882 |
|---|---|
| LBN Legal business name | Brodersen, Tara Vonne |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 18th, 2005 |
| Last updated | Mar 8th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336138882 | NPPES |
| Minnesota | Other | H400538336 | MEDICARE UPIN |
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