MEDICARE: EDSTROM & HELGESON, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	D12704	MN

General Provider Information

NPI Number	:	1811401375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDSTROM & HELGESON, P.A.

Provider Business Mailing Address
First Line	:	3436 DENMARK AVE
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1088
Country	:	US
Telephone Number	:	651-452-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 DENMARK AVE
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1088
Country	:	US
Telephone Number	:	651-452-4455
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRANDON C HELGESON
Credential	:	DDS
Telephone Number	:	651-452-4455

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	04/22/2021

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