| Integra Dental Pa | |
|
13783 Ibis St Nw Suite 400 Andover MN 55304-4892 | |
| (612) 384-0527 | |
| Not Available |
| Full Name | Integra Dental Pa |
|---|---|
| Speciality | Dentist |
| Location | 13783 Ibis St Nw, Andover, Minnesota |
| Authorized Official Name and Position | Gina L Andersland (OWNER/DENTIST) |
| Authorized Official Contact | 6123840527 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Integra Dental Pa 13783 Ibis St Nw Suite 400 Andover MN 55304-4892 Ph: (612) 384-0527 | Integra Dental Pa 13783 Ibis St Nw Suite 400 Andover MN 55304-4892 Ph: (612) 384-0527 |
| NPI Number | 1508201997 |
|---|---|
| Provider Enumeration Date | 04/30/2013 |
| Last Update Date | 04/30/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508201997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D13123 (Minnesota) | Secondary |
| 122300000X | Dentist | D12655 (Minnesota) | Primary |
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