Healthcare Provider Details

I. General information

NPI: 1710367925
Provider Name (Legal Business Name): LINDSAY BEDEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S STE 400
EDINA MN
55435-4549
US

IV. Provider business mailing address

1705 BROADWAY AVE S STE B
ROCHESTER MN
55904-7960
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD13555
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: