1376628081 NPI number — MS. CINDY ELLEN MCGREGORSAARELA

Table of content: MS. CINDY ELLEN MCGREGORSAARELA (NPI 1376628081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376628081 NPI number — MS. CINDY ELLEN MCGREGORSAARELA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGREGORSAARELA
Provider First Name:
CINDY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGREGOR
Provider Other First Name:
CINDY
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376628081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13725 57TH PL N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55446-3599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-559-9682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5585 LA CENTRE AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ALBERTVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55301-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-497-7730
Provider Business Practice Location Address Fax Number:
763-497-0177
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D11274 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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