Basic Information
| Provider Information | |||||||||
| NPI: | 1699745323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMPACH | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | D.D.S., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 DELAWARE STREET SE | ||||||||
| Address2: | 7-174 MOOS HEALTH SCIENCES TOWER | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123012233 | ||||||||
| FaxNumber: | 6126252669 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 DELAWARE STREET SE | ||||||||
| Address2: | 7-174 MOOS HEALTH SCIENCES TOWER | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123012233 | ||||||||
| FaxNumber: | 6126252669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204E00000X | D11128 | MN | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 1223S0112X | D11128 | MN | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.