Healthcare Provider Details

I. General information

NPI: 1376628081
Provider Name (Legal Business Name): MS. CINDY ELLEN MCGREGORSAARELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY ELLEN MCGREGOR D.D.S.

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5585 LA CENTRE AVE SUITE 500
ALBERTVILLE MN
55301-4519
US

IV. Provider business mailing address

13725 57TH PL N
PLYMOUTH MN
55446-3599
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-7730
  • Fax: 763-497-0177
Mailing address:
  • Phone: 763-559-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11274
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: