Healthcare Provider Details

I. General information

NPI: 1336127125
Provider Name (Legal Business Name): SUSAN JOAN MAGRAW D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BABCOCK BLVD E
DELANO MN
55328-2809
US

IV. Provider business mailing address

1320 BABCOCK BLVD E
DELANO MN
55328-2809
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-6574
  • Fax: 763-972-8503
Mailing address:
  • Phone: 763-972-6574
  • Fax: 763-972-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8609
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: